Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock, Nigel E.; Valle, Alejandro González Della; Go, George; Lyman, Stephen; Salvati, Eduardo A.

doi:10.1007/s11999-007-0092-4

Cited by 160 publications

(119 citation statements)

References 45 publications

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“…In contrast, several studies cite only a low risk of adverse bleeding events in patients receiving aspirin after TJA [27,36], while many have reported on clinically important bleeding risks associated with warfarin administration [15-17, 20, 22, 24-26, 29]. Sharrock et al [38] conducted a systematic review evaluating the association between anticoagulation regimens and all-cause mortality rates after TJA. Patients receiving aspirin were reported to have a significantly lower rate of all-cause mortality compared to patients on warfarin (0.19% versus 0.40%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Raphael

Tischler

Huang

et al. 2013

Clin Orthop Relat Res

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Background The most effective agent for prophylaxis against venous thromboembolic disease after total joint arthroplasty (TJA) remains unknown. The paucity of literature comparing different methods of pulmonary embolism (PE) prophylaxis and fear of litigation make it difficult for surgeons to abandon the use of aggressive chemical prophylaxis. Questions/purposes We compared the (1) overall frequency of symptomatic PE, (2) risk of symptomatic PE after propensity matching that adjusted for potentially confounding variables, and (3) other complications and length of stay before and after propensity matching in patients undergoing TJA at our institution who received either aspirin or warfarin prophylaxis. Methods A total of 28,923 patients underwent TJA between

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Section: Discussionmentioning

confidence: 99%

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Raphael

Tischler

Huang

et al. 2013

Clin Orthop Relat Res

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“…LMWHs can be administered subcutaneously, do not require laboratory monitoring, and are equally as effective as UFH [8]. The safety of LMWHs in postoperative orthopaedic patients has been the subject of much controversy [3,6,33]. To our knowledge, all studies conducted in patients undergoing arthroplasty to date have examined their use at lower prophylactic dosing rather than higher therapeutic doses.…”

Section: Introductionmentioning

confidence: 99%

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.

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“…Third, pneumatic compression boots and aspirin, along with regional anesthesia, are suggested as being noninferior to chemoprophylactic anticoagulants at preventing PE without the increased bleeding complications [6]. Interestingly, potent anticoagulants such as warfarin and LMWH are associated with increased all-cause mortality rates, including PE, when compared to pneumatic compression boots and aspirin [20]. It is from this point of view that the AAOS created the guidelines stating patients at a standard risk of both PE and bleeding can be given aspirin, LMWH, synthetic pentasaccharides, or warfarin to reach an INR goal of 2 or lower [11].…”

Section: Discussionmentioning

confidence: 99%

Does International Normalized Ratio Level Predict Pulmonary Embolism?

Hansen

Zmistowski

Restrepo

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Preventing pulmonary embolism is a priority after major musculoskeletal surgery. The literature contains discrepant data regarding the influence of anticoagulation on the incidence of pulmonary embolism after joint arthroplasty. The American College of Chest Physicians guidelines recommend administration of oral anticoagulants (warfarin), aiming for an international normalized ratio (INR) level between 2 and 3. However, recent studies show aggressive anticoagulation (INR [ 2) can lead to hematoma formation and increased risk of subsequent infection. Questions/purposes We asked whether an INR greater than 2 protects against pulmonary embolism. Patients and Methods We identified 9112 patients with 10,122 admissions for joint arthroplasty between 2004 and 2008. All patients received warfarin for prophylaxis, aiming for an INR level of 2 or lower. We assessed 609 of 10,122 admissions (6%) for pulmonary embolism using CT, ventilation/perfusion scan, or pulmonary angiography, and 163 of 10,122 admissions (1.6%) had a proven pulmonary embolism. Results Fifteen of 163 admissions (9%) had an INR greater than 2 before or on the day of workup compared to 35 of 446 admissions (8%) who were negative. We observed no difference between the INR values in patients with or without pulmonary embolism. Conclusions We found no clinically relevant difference in the INR values of patients who did or did not develop pulmonary embolism. The risk of bleeding should be weighed against the risk of pulmonary embolism when determining an appropriate target INR for each patient, as an INR less than 2 may reduce the risk of bleeding while still protecting against pulmonary embolism. Level of Evidence Level III, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

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Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Cited by 160 publications

References 45 publications

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Does International Normalized Ratio Level Predict Pulmonary Embolism?

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