OBJECTIVES:  Dabigatranetexilate (Pradaxa®) is an oral direct thrombin inhibitor. Clinical data show that once-daily Dabigatranetexilate 220mg is as effective as enoxaparin 40mg qd for the prophylaxis of venous thromboembolism following total hip or knee replacement surgeries (THR/TKR). However, an oral treatment for orthopaedic thromboprophylaxis offers potential benefits to hospitals when compared to the existing injectible low molecular heparins (LWMH) in terms of reduced administration costs. METHODS: A cost minimization analysis was performed from the perspective of acute care and rehabilitation hospitals in Germany. Use of Dabigatranetexilate following THR/TKR was compared to LWMH in six acute care and six rehabilitation hospitals. Nine hypotheses for possible administrative cost differences between a subcutaneaous and an oral anticoagulant were identified. Each hypothesis was separately examined and evaluated in each hospital using process cost analysis. Resource use and cost data were collected by using the hospitals’ own data and by interviewing and observing doctors and nurses. RESULTS:  The analysis shows that within the German hospital system the introduction of the new oral anticoagulation drug like Dabigatranetexilate might lead to an estimated saving of €2.43 per patient per day in an acute care hospital setting and €1.40 per patient per day in a rehabilitation hospital. Extrapolating this data to an acute care hospital that performs 1000 knee and hip replacements per year, with an average length of stay (LOS) of 10 days, use of an oral anticoagulant could reduce costs by approximately €24,300 per year. Extrapolating to a rehabilitation hospital that treats 1000 TKR/THR patients per year, with an average LOS of 21 days could potentially save the hospital €29,400 per year. CONCLUSIONS: Oral compared to subcutaneous thromboprophylaxis may reduce process costs significantly and resulting in high economic advantages for German hospitals.