title: The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement: a 15-year retrospective cohort study of routine clinical practice.
abstract: We examined the risk of thrombotic and major bleeding events in patients undergoing total hip and knee replacement (THR and TKR) treated with thromboprophylaxis, using nationwide population-based databases. We identified 83 756 primary procedures performed between 1997 and 2011. The outcomes were symptomatic venous thromboembolism (VTE), myocardial infarction (MI), stroke, death and major bleeding requiring hospitalisation within 90 days of surgery. A total of 1114 (1.3%) and 483 (0.6%) patients experienced VTE and bleeding, respectively. The annual risk of VTE varied between 0.9% and 1.6%, and of bleeding between 0.4% and 0.8%. The risk of VTE and bleeding was unchanged over a 15-year period. A total of 0.7% of patients died within 90 days, with a decrease from 1% in 1997 to 0.6% in 2011 (p < 0.001). A high level of comorbidity and general anaesthesia were strong risk factors for both VTE and bleeding, with no difference between THR and TKR patients. The risk of both MI and stroke was 0.5%, which remained unchanged during the study period. In this cohort study of patients undergoing THR and TKR patients in routine clinical practice, approximately 3% experienced VTE, MI, stroke or bleeding. These risks did not decline during the 15-year study period, but the risk of dying fell substantially.
authors.affiliation: Aarhus University Hospital, Department of Clinical Epidemiology, Olof Palmes Alle 43-45, Aarhus, 8200, Denmark.
authors.forename: A B
authors.initials: AB
authors.lastname: Pedersen
authors.forename: F
authors.initials: F
authors.lastname: Mehnert
authors.forename: H T
authors.initials: HT
authors.lastname: Sorensen
authors.forename: C
authors.initials: C
authors.lastname: Emmeluth
authors.forename: S
authors.initials: S
authors.lastname: Overgaard
authors.forename: S P
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Bleeding; Hip Prosthesis; Knee Prosthesis; Myocardial infarction; Risk factors; Stroke; Trends; Venous thromboembolism