High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline

Leijtens, Borg; Hei, Keetie Kremers van de; Jansen, Justus; Koëter, Sander

doi:10.1007/s00402-014-2034-4

Cited by 27 publications

(23 citation statements)

References 25 publications

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“…Given the signifi cantly higher incidence of bleeding complications and insignifi cant difference in the incidence of ischaemic complications in patients after THA or TKA compared to patients after other orthopaedic procedures, we can ask whether consistent perioperative anticoagulation prophylaxis in patients with arthroplasty may be the reason for the reduced incidence of ischaemic complications or the cause of increased incidence of bleeding complications (4,5,7,12,15,16). We cannot answer this speculative question based on the results achieved in our study.…”

Section: Discussionmentioning

confidence: 84%

“…We believe this to be especially due to the fact that considerable resection of connective tissue and signifi cant exposure of spongy bone occur after both procedures, meaning that perioperative and subsequent postoperative blood losses are signifi cant in both THA and TKA. Moreover, perioperative anticoagulation prophylaxis, which is recommended in all these patients, is consistently applied in our patients using low-molecular-weight heparins (2,12). Other procedures performed in patients of the study group included also surgeries where higher perioperative blood losses are seen (scoliosis, arthroplasty of the shoulder, internal fi xation of the pelvic fracture); however, the number of these procedures was considerably lower in our group compared to procedures associated with minimum perioperative bleeding (cerclage of the olecranon, open reduction and internal fi xation for forearm fractures, proximal femoral nail and dynamic hip screw for hip fractures, cerclage of the patella, non-reamed tibial nail for tibial fractures, open reduction and internal fi xation for ankle fractures).…”

Section: Discussionmentioning

confidence: 99%

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THA and TKA in patients with cardiovascular disease: What makes the risk of perioperative bleeding?

Džupa¹,

Motovska²,

Widimský³

et al. 2017

BLL

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BACKROUND: The purpose of the study was to ascertain the incidence of bleeding and ischaemic complications in patients with cardiac disease after total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: In total, 477 patients (289 women, 188 men) with known history of cardiac disease or thromboembolic disease treated with surgery in 2010-2013, were enrolled in the study. Perioperative prevention of thromboembolic disease using low-molecular-weight heparins was applied in all the patients. The data that could have an impact on the development of monitored perioperative complications, were observed. RESULTS: Complications occurred in 55 (11.6 %) patients: bleeding complications in 32, ischaemic in 19, and both in four patients. Complications were found in 13 (12.0 %) patients after THA and in 6 (9.5 %) patients after TKA. Bleeding complications were observed in 17 patients after THA and TKA, ischaemic in one, and both simultaneously in one patient. Bleeding complications occurred insignifi cantly more frequently after THA and TKA (p = 0.094); however, this difference was statistically signifi cant after adjustment for risk factors (p = 0.003). On the contrary, ischaemic complications were signifi cantly more frequent after other skeletal surgeries (p = 0.014). Nevertheless, this difference was not statistically signifi cant after the adjustment (p = 0.880). The comparison of the risk of complications in patients after THA with that in patients after TKA showed no signifi cant difference (p = 0.580). CONCLUSION: The study showed a signifi cantly higher incidence of bleeding complications in patients after THA and TKA compared to other surgeries of the musculoskeletal system in patients with a history of cardiac disease. Bleeding complications cannot be detected in advance (Tab. 1, Ref. 16). Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

THA and TKA in patients with cardiovascular disease: What makes the risk of perioperative bleeding?

Džupa¹,

Motovska²,

Widimský³

et al. 2017

BLL

View full text Add to dashboard Cite

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“…2013, Leijtens et al. 2014). In the present study, MBs occurred in less than 2% of bridged patients, despite the fact that THA and TKA may be considered to be high-risk procedures (Douketis et al.…”

Section: Discussionmentioning

confidence: 99%

“…This contrasts with 2 other small cohort studies in THA and TKA, which had major bleeding rates of 92% and 33% (Leijtens et al. 2014, Haighton et al. 2015).…”

Section: Discussionmentioning

confidence: 99%

Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties

Jørgensen

Kehlet

2016

Acta Orthopaedica

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Background — The benefit of preoperative bridging in surgical patients with continuous anticoagulant therapy is debatable, and drawing of meaningful conclusions may have been limited by mixed procedures with different thromboembolic and bleeding risks in most published studies.Patients and methods — This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K antagonist (VKA) treatment. We performed 30-day follow-up on in-hospital complications and re-admissions through the Danish National Patient Registry and patient records.Results — Of 13,375 procedures, 649 (4.7%) were in VKA patients with a mean age of 73 (SD 9) years and a median length of stay of 3 days (IQR: 2–4). Preoperative bridging was used in 430 (67%), while 215 (33%) were paused. Of 4 arterial thromboembolic events (ATEs) (0.6%), 2 were in paused patients and 2 were in bridged patients (p = 0.6). Of 3 venous thromboembolic events (VTEs) (0.5%), 2 were in paused patients and 1 was in a bridged patient (p = 0.3). Of 8 major bleedings (MBs) (1.2%), 1 was in a paused patient and 7 were in bridged patients (p = 0.3), 5 of whom received therapeutic bridging. Similar results were found in a propensity-matched cohort.Interpretation — In contrast to recent studies in mixed surgical procedures, no statistically significant differences in ATE, VTE, or MB were found between preoperative bridging and pausation of VKA patients. However, the higher number of thromboembolic events in paused patients and the higher number of major bleedings in bridged patients warrant more extensive investigation.

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“…Leijtens et al . found a 92% incidence of major bleeding complications after joint replacement associated with bridging anticoagulation utilizing the 2012 American College of Chest Physicians guidelines . Similarly, a large observational cohort study of patients with coronary stents who underwent non‐cardiac surgery documented a 9.5% incidence of bleeding complications, nearly all of which were deemed major and required reoperation in 18.5% of cases in which bleeding occurred.…”

mentioning

confidence: 99%

Challenge of periprocedural management of anticoagulants and antiplatelet therapy

Fitridge

2015

ANZ Journal of Surgery

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High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline

Cited by 27 publications

References 25 publications

THA and TKA in patients with cardiovascular disease: What makes the risk of perioperative bleeding?

THA and TKA in patients with cardiovascular disease: What makes the risk of perioperative bleeding?

Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties

Challenge of periprocedural management of anticoagulants and antiplatelet therapy

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