title: High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline.
abstract: BACKGROUND
  An increasing amount of patients receiving total joint replacement require bridging of long-term anticoagulants. Guidelines, aimed at preventing complications, focus on thromboembolic events but not on bleeding complications. In this retrospective observational study, bleeding and thromboemoblic (TE) complications were evaluated in patients requiring perioperative heparin bridging of antithrombotic therapy during primary unilateral total hip or knee arthroplasty (THA and TKA).
  
  
  METHODS
  Between January 2011 and June 2012, we identified all patients receiving low molecular weight heparin (LMWH) bridging during THA or TKA, according to our local protocol based on the ACCP guideline. Bleeding and TE complications, interventions and patient-related outcome measurements were used for evaluation.
  
  
  RESULTS
  Among 972 patients 13 patients required bridging. Twelve patients (92%) experienced bleeding complications. An intervention was required in nine patients (69%). Seven patients received blood transfusion (54%). Nine patients (69%) developed a hematoma and two patients (15%) a periprosthetic joint infection. A total of five patients were re-admitted to hospital (39%) and the length of stay increased in all patients. No TE complications were observed in any of these patients. One year results of this patient group seem to be good.
  
  
  CONCLUSIONS
  This study shows an alarmingly high complication rate in patients receiving LMWH bridging during elective TKA or THA surgery. All complications seem to be caused by, or secondary to bleeding. Patients need to be consulted about the risk of bleeding complications, and the risk of bleeding needs to be balanced over the risk of TE complications.
authors.affiliation: Department of Orthopedic Surgery, Radboud University, Medical Centre, Geert Grooteplein-Zuid 10, huispost 357, Postbus 9101, 6500 HB, Nijmegen, The Netherlands, borgleijtens@gmail.com.
authors.forename: Borg
authors.initials: B
authors.lastname: Leijtens
authors.forename: Keetie
authors.initials: K
authors.lastname: Kremers van de Hei
authors.forename: Justus
authors.initials: J
authors.lastname: Jansen
authors.forename: Sander
authors.initials: S
authors.lastname: Koëter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D017558:Elective Surgical Procedures; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight