title: Warfarin for thromboprophylaxis following total joint arthroplasty: are patients safely anti-coagulated?
abstract: The purpose of this study was to investigate whether any correlation exists between INR level at discharge and postoperative complications or readmission rates. From 2010-2011, INR levels on discharge, complications and readmissions within 30 days were recorded on 441 patients undergoing joint arthroplasty. Eighty percent (352 of 441) patients had a subtherapeutic INR level at discharge. The overall complication rate was 15% with an 8.6% readmission rate. A supratherapeutic INR level at discharge was associated with both higher readmission rate as well as increased number of complications (P<0.048). Most patients taking warfarin are nontherapeutic at the time of discharge; notably, a supratherapeutic INR places patients at risk for increased complications and readmissions rates following surgery.
authors.affiliation: Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Aynardi
authors.forename: P Benedict
authors.initials: PB
authors.lastname: Brown
authors.forename: Zachary
authors.initials: Z
authors.lastname: Post
authors.forename: Fabio
authors.initials: F
authors.lastname: Orozco
authors.forename: Alvin
authors.initials: A
authors.lastname: Ong
mesh_terms: D000367:Age Factors; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: International Normalized Ratio (INR); complications; joint replacement; thromboprophylaxis; warfarin