Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty

Nigel E. Sharrock, Alejandro Gonzalez Della Valle, George Go, Stephen Lyman, Eduardo A. Salvati

Research output: Contribution to journalArticlepeer-review

123 Citations (Scopus)

Abstract

Anticoagulation for thromboprophylaxis after THA and TKA has not been confirmed to diminish all-cause mortality. We determined whether the incidence of all-cause mortality and pulmonary embolism in patients undergoing total joint arthroplasty differs with currently used thromboprophylaxis protocols. We reviewed articles published from 1998 to 2007 that included 6-week or 3-month incidence of all-cause mortality and symptomatic, nonfatal pulmonary embolism. Twenty studies included reported 15,839 patients receiving low-molecular-weight heparin, ximelagatran, fondaparinux, or rivaroxaban (Group A); 7193 receiving regional anesthesia, pneumatic compression, and aspirin (Group B); and 5006 receiving warfarin (Group C). All-cause mortality was higher in Group A than in Group B (0.41% versus 0.19%) and the incidence of clinical nonfatal pulmonary embolus was higher in Group A than in Group B (0.60% versus 0.35%). The incidences of all-cause mortality and nonfatal pulmonary embolism in Group C were similar to those in Group A (0.4 and 0.52, respectively). Clinical pulmonary embolus occurs despite the use of anticoagulants. Group A anticoagulants were associated with the highest all-cause mortality of the three modalities studied. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)714-721
Number of pages8
JournalClinical orthopaedics and related research
Volume466
Issue number3
DOIs
Publication statusPublished - Mar 2008

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

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