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Objective: Currently, rivaroxaban is widely used clinically for thromboprophylaxis after surgery. However, thereare concerns on effectiveness and safety of rivaroxaban for its proper use. We aimed to evaluate the effectivenessand safety of rivaroxaban in orthopaedic patients after total hip replacement surgery in a large medicalcentre after the preferred formulary was switched from enoxaparin to rivaroxaban. Methods: The study wasconducted on the patients who underwent hip arthroplasty surgery at the department of Orthopaedic Surgery atSeoul St. Mary’s Hospital, South Korea. Electronic medical records were retrospectively reviewed to identifypatients treated with rivaroxaban following total hip replacement between February 2011 and March 2012. Evaluation criteria included indications for use, dose, initiation and duration of therapy, drug interactions,adverse reactions, and status of health care reimbursement. The patients who were on enoxaparin were alsoreviewed as a reference. Results: We identified 57 patients who received rivaroxaban and 50 who receivedenoxaparin. All patients were prescribed the drugs for Korean Food and Drug Administration–approved indications. No thromboembolic or bleeding events were observed in either group. However, only 5.3% of rivaroxaban-treated patients had an appropriate length of prophylaxis and only 3.5% began rivaroxaban treatment at therecommended time. Surprisingly, 47.4% of rivaroxaban-treated patients received rivaroxaban despite being ineligiblefor reimbursement benefits. Conclusion: Rivaroxaban was generally well tolerated clinically. However, theduration of treatment, the time of initiation and patient eligibility for reimbursement require improvements,emphasising the need for education which indicates the area of pharmacists’ involvement.