title: Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty.
abstract: BACKGROUND
  Patients scheduled for elective surgery with a high risk of thromboembolism require anticoagulation bridging therapy perioperatively. The purpose of this study was to assess the risk of thromboembolic events and bleeding-related complications after total hip and knee arthroplasty in patients requiring bridging therapy for anticoagulants.
  
  
  METHODS
  A retrospective cohort study of all patients with primary total hip or total knee replacement in a 4-year period was performed. Outcome measures were blood loss, thromboembolic and bleeding-related complications and hospital stay.
  
  
  RESULTS
  Bridged patients had more blood loss and higher complication rates than the control group. Most complications were bleeding-related, and there were no thromboembolic events. Seven of the 14 (50%) total hip patients bridged with unfractioned heparin required reoperation (three patients with ischial neuropraxia due to hematoma). There were two bleeding-related deaths in total hip patients bridged with low-molecular-weight heparin. Mean hospital stay was significantly longer in unfractioned heparin bridging.
  
  
  CONCLUSIONS
  In this study, there was a significant increase in bleeding-related complications in total joint replacement with bridging therapy compared to prophylaxis. This risk was highest in patients with total hip arthroplasty. There were no thromboembolic events in bridged patients.
authors.affiliation: Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands. haighton.martijn@gmail.com.
authors.forename: Martijn
authors.initials: M
authors.lastname: Haighton
authors.affiliation: Department of Orthopaedic Surgery, OLVG Hospital, Oosterpark 9, 1091, AC, Amsterdam, The Netherlands. d.h.r.kempen@gmail.com.
authors.forename: Diederik H R
authors.initials: DH
authors.lastname: Kempen
authors.affiliation: Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands. n.wolterbeek@antoniusziekenhuis.nl.
authors.forename: Nienke
authors.initials: N
authors.lastname: Wolterbeek
authors.affiliation: Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands. l.marting@antoniusziekenhuis.nl.
authors.forename: Louis N
authors.initials: LN
authors.lastname: Marting
authors.affiliation: Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands. m.van.dijk@antoniusziekenhuis.nl.
authors.forename: Martijn
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands. m.r.veen@antoniusziekenhuis.nl.
authors.forename: Remmelt M R
authors.initials: RM
authors.lastname: Veen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced / Q000175:diagnosis
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight