Perioperative medicine & outcomes
Venous Thromboembolism in Total Hip and Total Knee Arthroplasty
Main finding · VTEResult — go to the resultOdds ratio 1.14 95% CI 0.82–1.59Authors' conclusion
In this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin.
Study context
- Population
- US patients with hip or knee arthroplasty, continuous insurance enrollment 3 months before and after surgery, receiving a single postsurgical pharmacological thromboprophylaxis agent, no preoperative anticoagulation
- Participants
- 29,264 patients · 7,844 matched direct oral anticoagulant (DOAC)-aspirin pairs
- Exposure
- DOAC vs aspirin thromboprophylaxis after total hip or knee arthroplasty
- DOACn = 7,844
- Aspirinn = 7,844reference
- Outcome
- Cumulative incidence of postdischarge VTE
- Follow-up
- 30 days
Methodological detailsclaims database, propensity-matched analysis
- Claims database
- Propensity-matched analysis
Main finding
VTE
Odds ratio
1.14
95% CI 0.82–1.59
DOAC vs Aspirin
OR 1.14 (95% CI 0.82–1.59)
As reported in the abstract
- Cumulative incidence of venous thromboembolism (VTE), whole cohort
- 1.19% (95% CI, 1.06%-1.32%)
Observational data: associations, not effects.
Further findings
Risk factors for VTE (multivariate analysis)
- Prior VTE history, OR
- 5.94 (95% CI, 4.29-8.24)
- Hereditary hypercoagulable state, OR
- 2.64 (95% CI, 1.32-5.28)
- Knee arthroplasty, OR
- 1.65 (95% CI, 1.29-2.10)
- Male sex, OR
- 1.34 (95% CI, 1.08-1.67)
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Postoperative bleeding · 30 daysMore frequent with DOACs · propensity-matched cohort | 1.36 (1.13–1.62) | |
| 0.512Odds ratio (log scale) |
- Postoperative bleeding — Cumulative incidence of bleeding, whole cohort
- 3.43% (95% CI, 3.22%-3.64%)
Original publication
Venous Thromboembolism in Total Hip and Total Knee Arthroplasty. JAMA Netw Open. Published 1 December 2023. doi:10.
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