Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty

Journal of Orthopaedic Surgery and Research

Remmelt M R Veen¹  Martijn van Dijk¹  Louis N. Marting¹  Nienke Wolterbeek¹  Diederik H R Kempen²  Martijn Haighton¹ 

[1] Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, 3430, EM, The Netherlands;Department of Orthopaedic Surgery, OLVG Hospital, Oosterpark 9, Amsterdam, 1091, AC, The Netherlands

关键词: Bleeding;    Complications;    Total knee arthroplasty;    Total hip arthroplasty;    Heparin;    Bridging;    Vitamin K antagonists;    Anticoagulation;   

Others  :  1227810
DOI  :  10.1186/s13018-015-0285-6

 received in 2015-06-25, accepted in 2015-09-01,  发布年份 2015

【 摘 要 】

Background

Patients scheduled for elective surgery with a high risk of thromboembolism require anticoagulation bridging therapy perioperatively. The purpose of this study was to assess the risk of thromboembolic events and bleeding-related complications after total hip and knee arthroplasty in patients requiring bridging therapy for anticoagulants.

Methods

A retrospective cohort study of all patients with primary total hip or total knee replacement in a 4-year period was performed. Outcome measures were blood loss, thromboembolic and bleeding-related complications and hospital stay.

Results

Bridged patients had more blood loss and higher complication rates than the control group. Most complications were bleeding-related, and there were no thromboembolic events. Seven of the 14 (50 %) total hip patients bridged with unfractioned heparin required reoperation (three patients with ischial neuropraxia due to hematoma). There were two bleeding-related deaths in total hip patients bridged with low-molecular-weight heparin. Mean hospital stay was significantly longer in unfractioned heparin bridging.

Conclusion

In this study, there was a significant increase in bleeding-related complications in total joint replacement with bridging therapy compared to prophylaxis. This risk was highest in patients with total hip arthroplasty. There were no thromboembolic events in bridged patients.

【 授权许可】

   
2015 Haighton et al.

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