Surgeons anticipate approval, adoption of new anticoagulant drugs

In light of the positive FDA advisory committee review of rivaroxaban (Xarelto; Bayer Schering/Ortho-McNeil), one of multiple anticoagulants in development, many expect this new group of anticoagulant drugs to be on the market in the next 1 to 3 years. Experts at the American Academy of Orthopaedic Surgeons 76th Annual Meeting discussed the probable adoption of these drugs in their own practices and among their peers.

“As orthopedic surgeons, we look very critically at safety; we look very critically at efficacy. I think it is fair to say, if we consider those to be equal and the dosing schedule is equal, [that is, if] they are both once-a-day, then it comes down to cost,” Richard J. Friedman, MD, said. “If you have a twice-a-day [and a] once-a-day, you would probably go for the once-a-day. But we are looking [at] safety first and efficacy afterward.”

Fred D. Cushner, MD, voiced his opinion on who among their peers might adopt use of the new drugs.

“Often in orthopedics, even the best of folks take a long time to incorporate and change practice patterns,” Cushner said. “The big question is, who is going to switch? … This is debatable, but my personal opinion is the injectables will probably be the first to go.”

Friedman agreed, saying, “It is hard to predict. … Clearly those people who have been using low-molecular-weight heparin injectables for a long time and are comfortable with those – and [the risks] associated with them – they will switch over pretty quickly, because you have all the advantages of low-molecular-weight heparin, but it is a pill.”

He added, “I think the warfarin users will keep a close eye on the low-molecular-weight heparin colleagues and watch things very carefully. They will sort of dip their toes in the water ... to try it with some high-risk patients first, get a little experience with the drug, and gradually it will evolve over time.”