Patient Preferences for an Oral Anticoagulant after Major Orthopedic Surgery Results of a German Survey

Background: Since 2008, the availability of the oral direct thrombin inhibitor dabigatran etexilate provides a further therapeutic alternative to injectable low-molecular-weight heparin (LMWH) for thromboprophylaxis following hip or knee replacement surgery. The intention of this study is to analyze patient preferences for this new oral thromboprophylaxis agent. Methods: Face-to-face interviews were conducted with 73 doctors and nurses in 12 German hospitals, 195 current hip and knee replacement patients in six German rehabilitation hospitals, and 202 former thromboprophylaxis patients. Qualitative questions were complemented by a full-profile ranking-based conjoint analysis regarding alternative thromboprophylaxis regimens. Results: Nearly 100% of the interviewed medical staff viewed the daily subcutaneous LMWH injection as a source of inconvenience for patients. However, both current and former patients perceived their discomfort to be much less intense. In contrast, the conjoint estimates of preferences showed that older and male patients in particular understated their levels of discomfort in a face-to-face interview situation and had a strong preference for oral anticoagulation. Conclusions: Patients in Germany appear to have a positive preference for oral thromboprophylaxis after major orthopedic surgery.