Venous Thromboembolism in Total Hip and Total Knee Arthroplasty

• DOI: 10.1001/jamanetworkopen.2023.45883
• Publication Date: 2023-12-01T16:31:03Z
• Authors: Samantha J. Simon; Rushad Patell; Jeffrey I. Zwicker; Dhruv S. Kazi; Brian L. Hollenbeck
• Keywords: Apixaban; Cumulative incidence

Importance The optimal pharmacologic thromboprophylaxis agent after total hip and knee arthroplasty is uncertain consensus lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) bleeding evaluating comparative effectiveness safety strategies can inform care. Objective To quantify factors for VTE compare patient outcomes among pharmacological agents used arthroplasty. Design, Setting, Participants This retrospective cohort study data from a large health care claims database. included patients in United States with or continuous insurance enrollment 3 months prior to following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, no postsurgical thromboprophylaxis, had multiple postsurgery thromboprophylactic agents. In propensity-matched analysis, receiving direct oral anticoagulant (DOAC) matched those aspirin. Exposures Aspirin, apixaban, rivaroxaban, enoxaparin, warfarin. Main Outcomes Measures primary outcome was 30-day cumulative incidence postdischarge VTE. Other bleeding. Results Among 29 264 final cohort, 17 040 (58.2%) female, 27 897 (95.2%) inpatient admissions median (IQR) length stay 2 (1-2) days, 10 948 (37.4%) underwent arthroplasty, 18 316 (62.6%) arthroplasty; age 59 (55-63) years. At 30 1.19% (95% CI, 1.06%-1.32%) 3.43% 3.22%-3.64%). multivariate leading associated increased history (odds ratio [OR], 5.94 [95% 4.29-8.24]), hereditary hypercoagulable state (OR, 2.64 1.32-5.28]), 1.65 1.29-2.10]), male sex 1.34 1.08-1.67]). 7844 DOAC-aspirin pairs, there significant difference first days procedure 1.14 0.82-1.59]), but more frequent DOACs 1.36 1.13-1.62]). Conclusions Relevance this who underlying factors, not choice aspirin DOAC, Postoperative rates lower prescribed These results suggest that should be patient-centric tailored individual thrombosis