Clinical and pharmacological risk assessment for thrombohaemorrhagic complications after total lower limb arthroplasty

Abstract

Background. Anticoagulant and haemostatic drugs are used to prevent thrombosis and bleeding after arthroplasty. Combined therapy with these divergent agents, especially in comorbid patients, is not regulated in relevant clinical guidelines and may lead to a reduced effi cacy.Objectives. Assessment of the effect of time interval (TI) in variant combined settings of haemostatic and anticoagulant drugs and concomitant pathology on the development of thrombohaemorrhagic complications after hip or knee arthroplasty.Мethods. In a retrospective study, we analysed patients’ somatic status, haemostatic and anticoagulant drug regimes and their combined impact on the development of thrombohaemorrhagic complications in early postoperative period.Results. We analysed 253 case histories with total replacement of main lower limb joints. Two cohorts were defi ned with respect to TI between haemostatic and anticoagulant drug applications. TI was 17 h or less (n = 145; 57.31%) in cohort 1 and 18–24 h (n = 108; 42.68%) — in cohort 2. A total of 29 drug combinations were tested. Thrombohaemorrhagic complications were observed in 27 (10.67%) patients, with 22 (81.48%) in cohort 1. Thromboses in regimes with tranexamic acid developed in cohort 1 (p = 0.038) at a 2.2-folds higher rate than in cohort 2 (p < 0.05). Thrombosis development was infl uenced by grade 2 obesity (relative risk = 8.75, p = 0.037), type 2 diabetes (relative risk = 21, p = 0.00001), myocardial infarction (relative risk = 16.875, p = 0.00002), venous pathology (relative risk = 8.1, p = 0.045) and the patient’s age over 75 (relative risk = 6.8, p = 0.029). Age over 75 years increased the risk of bleeding by a factor of 12 (relative risk = 12, p = 0.015).Conclusion. After main joint arthroplasty, differential measures to prevent thrombohaemorrhagic complications include a minimal 18-h TI between haemostatic and anticoagulant agent applications, especially in tranexamic acid regimes, and the consideration of concomitant risk factors, such as grade 2 obesity, type 2 diabetes, myocardial infarction in history, venous pathology and age over 75 years.