Association between duration of anticoagulant thromboprophylaxis and revision rate in primary total hip arthroplasty: a Danish and Norwegian nationwide cohort study

• Published in: Acta orthopaedica 2022-12, Vol.93
• Main Authors: Vinther, Dennis, Mailhac, Aurelie, Andersen, Ina Trolle, Overgaard, Søren, Lie, Stein Atle, Fenstad, Anne Marie, Gjertsen, Jan-Erik, Furnes, Ove, Pedersen, Alma B
• Format: Article
• Language: English
• Subjects: Anticoagulants - therapeutic use; Arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Cohort Studies; Denmark - epidemiology; Hip; Hip Prosthesis - adverse effects; Humans; Implants; Norway - epidemiology; Prosthesis-Related Infections - etiology; Registries; Reoperation - adverse effects; Revision; Risk Factors; Thromboprophylaxis; Venous Thromboembolism - epidemiology; Venous Thromboembolism - prevention & control
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.2340/17453674.2022.6243

There are concerns that bleeding following primary total hip arthroplasty (THA) contributes to prolonged wound drainage and prosthetic joint infection (PJI). We examined whether short (1-5 days), medium (6-14 days), and extended (≥ 15 days) duration of thromboprophylaxis is associated with the 5-year revision rate after THA due to osteoarthritis. We performed a cohort study based on data from hip arthroplasty and administrative registries in Denmark and Norway (2008-2014). The outcome was revision surgery due to PJI, aseptic loosening or any cause, and patient mortality. Adjusted cause-specific hazard ratios (HRs) were analyzed with Cox regression analyses. Among 50,482 THA patients, 8,333 received short, 17,009 received medium, and 25,140 received extended thromboprophylaxis. The HRs for revision due to PJI within 5 years were 1.0 (95%CI 0.7-1.3) and 1.1 (CI 0.9-1.3) for short and extended vs. medium treatment, whereas HR for extended vs. medium prophylaxis was 1.5 (CI 1.2-2.0) within 3 months. The HRs for revision due to aseptic loosening within 5 years were 1.0 (CI 0.7-1.4) and 1.1 (CI 0.9-1.4) for short and extended vs. medium treatment. The HRs for any revision within 5 years were 0.9 (CI 0.8-1.1) and 0.9 (CI 0.8-1.0) for short and extended vs. medium treatment. Extended vs. medium prophylaxis was associated with a decreased 0-3 month mortality. The absolute differences at 5 years were ≤ 1%. Our data suggests no association between duration of anticoagulant thromboprophylaxis and revision rate within 5 years of primary THA. The extended thromboprophylaxis might be associated with early increased revision rate due to PJI but also with lower mortality; however, the clinical relevance of this finding requires further research.