title: Complications of perioperative warfarin therapy in total knee arthroplasty.
abstract: Patients presenting for knee replacement on warfarin for medical reasons often require higher levels of anticoagulation peri-operatively than primary thromboprophylaxis and may require bridging therapy with heparin. We performed a retrospective case control study on 149 consecutive primary knee arthroplasty patients to investigate whether anti-coagulation affected short-term outcomes. Specific outcome measures indicated significant increases in prolonged wound drainage (26.8% of cases vs 7.3% of controls, P<0.001); superficial infection (16.8% vs 3.3%, P<0.001); deep infection (6.0% vs 0%, P<0.001); return-to-theatre for washout (4.7% vs 0.7%, P=0.004); and revision (4.7% vs 0.3%, P=0.001). Management of patients on long-term warfarin therapy following TKR is particularly challenging, as the surgeon must balance risk of thromboembolism against post-operative complications on an individual patient basis in order to optimise outcomes.
authors.affiliation: Royal Infirmary of Edinburgh, United Kingdom.
authors.forename: Phil M S
authors.initials: PM
authors.lastname: Simpson
authors.affiliation: Bradford Royal Infirmary, United Kingdom.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Brew
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Whitehouse
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia; The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Ross W
authors.initials: RW
authors.lastname: Crawford
authors.affiliation: Brisbane Orthopaedic Specialist Services, Holy Spirit Northside Hospital, Queensland, Australia.
authors.forename: Bill J
authors.initials: BJ
authors.lastname: Donnelly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulation; bridging; complications; heparin; total knee arthroplasty; warfarin