For specialist use in secondary care only.
For further information, refer to NICE NG89 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism .
| Choice | Drug | Dosage |
| 1st choices oral anticoagulant for VTE in orthopaedic surgery | Apixaban▼ tablets 2.5mg | Dose: Prophylaxis of venous thromboembolism following knee replacement surgery – 2.5mg twice daily for 10-14 days, starting 12-24 hours after surgery Prophylaxis of venous thromboembolism following hip replacement surgery, 2.5mg twice daily for 32-38 days, starting 12-24 hours after surgery |
| Or | ||
| Dabigatran capsules 75mg, 110mg | Dose: Prophylaxis of venous thromboembolism following total knee replacement surgery- 110mg (ELDERLY over 75 years, 75mg) 1-4 hours after surgery, followed by 220mg (ELDERLY over 75 years, 150mg) once daily for 10 days, to be taken on the first day after surgery | |
| Or | ||
| Rivaroxaban▼ tablets 10mg | Dose: 10mg once daily, starting 6-10 hours after surgery, provided that haemostasis has been established 5 weeks treatment for hip replacement 2 weeks treatment for knee replacement |
Prescribing Notes
- Abixaban▼, dabigatran and rivaroxaban▼ are approved for specialist use only, in hip and knee replacement surgery, for prophylaxis of venous thromboembolism.
- NICE have issued a number of pieces of guidance in relation to the newer oral anticoagulants and the prophylaxis of venous thromboembolism-listed below for information:
-
- NICE TA 157 (September 2008) Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee surgery in adults
- NICE TA 170 (April 2009) Rivaroxaban▼ for the prevention of venous thromboembolism after total hip or total knee replacement in adults
- NICE TA 245 (January 2012) Apixaban▼ for the prevention of venous thromboembolism after total hip or knee replacements in adults
- Dabigatran capsules cannot be crushed or opened and cannot be used in standard compliance aids due to the instability of the drug.
- MHRA have received a small number of reports suggesting lack of efficacy (thromboembolic events) in patients taking 15mg or 20mg rivaroxaban on an empty stomach; remind patients to take rivaroxaban 15mg or 20mg tablets with food.