Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty.

Abstract

BACKGROUND:

Patients scheduled for elective surgery with a high risk of thromboembolism require anticoagulation bridging therapy perioperatively. The purpose of this study was to assess the risk of thromboembolic events and bleeding-related complications after total hip and knee arthroplasty in patients requiring bridging therapy for anticoagulants.

METHODS:

A retrospective cohort study of all patients with primary total hip or total knee replacement in a 4-year period was performed. Outcome measures were blood loss, thromboembolic and bleeding-related complications and hospital stay.

RESULTS:

Bridged patients had more blood loss and higher complication rates than the control group. Most complications were bleeding-related, and there were no thromboembolic events. Seven of the 14 (50%) total hip patients bridged with unfractioned heparin required reoperation (three patients with ischial neuropraxia due to hematoma). There were two bleeding-related deaths in total hip patients bridged with low-molecular-weight heparin. Mean hospital stay was significantly longer in unfractioned heparin bridging.

CONCLUSION:

In this study, there was a significant increase in bleeding-related complications in total joint replacement with bridging therapy compared to prophylaxis. This risk was highest in patients with total hip arthroplasty. There were no thromboembolic events in bridged patients.

• Authors: Martijn Haighton, Diederik H R Kempen, Nienke Wolterbeek, Louis N Marting, Martijn van Dijk, Remmelt M R Veen
• Journal: Journal of orthopaedic surgery and research (J Orthop Surg Res) Vol. 10 Pg. 145 (Sep 17 2015) ISSN: 1749-799X [Electronic] England
• PMID: 26384316 (Publication Type: Journal Article)

Chemical References

• Anticoagulants
• Heparin, Low-Molecular-Weight

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage, adverse effects)
• Arthroplasty, Replacement, Hip (adverse effects)
• Arthroplasty, Replacement, Knee (adverse effects)
• Cohort Studies
• Drug Administration Schedule
• Female
• Heparin, Low-Molecular-Weight (administration & dosage, adverse effects)
• Humans
• Male
• Middle Aged
• Postoperative Hemorrhage (chemically induced, diagnosis)
• Retrospective Studies
• Risk Factors
• Thromboembolism (chemically induced, diagnosis)