Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty.
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.
Sharrock
Nigel E
NE
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. sharrockn@hss.edu
Gonzalez Della Valle
Alejandro
A
Go
George
G
Lyman
Stephen
S
Salvati
Eduardo A
EA
D000765:Anesthesia, Conduction / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality*; D001241:Aspirin / Q000009:adverse effects; D001384:Azetidines / Q000009:adverse effects; D001596:Benzylamines / Q000009:adverse effects; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices / Q000009:adverse effects; D009025:Morpholines / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011134:Polysaccharides / Q000009:adverse effects; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects
D000925:Anticoagulants; D001384:Azetidines; D001596:Benzylamines; D006495:Heparin, Low-Molecular-Weight; D009025:Morpholines; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D013876:Thiophenes; C426686:ximelagatran; D014859:Warfarin; D000069552:Rivaroxaban; D000077425:Fondaparinux; D001241:Aspirin