The risks of pulmonary embolism and upper gastrointestinal bleeding beyond 35days after total hip replacement for coxarthrosis among middle-aged patients: A cross-over cohort.
Prophylactic anticoagulation is recommended up to 35days after total hip replacement (THR). Although several observational studies have assessed the incidence of thrombotic events or bleeding events after THR, the corresponding measures of association have never been studied concomitantly. Here, we evaluated the duration of the elevated risks (relative to the baseline risk) of both venous thromboembolic events and bleeding events after THR for coxarthrosis among middle-aged patients. This was a population-based, cross-over cohort study of data extracted from the French national inpatient database between 2007 and 2013. We included middle-aged patients (aged 45 to 69) having undergone THR for coxarthrosis. We compared the numbers of pulmonary embolisms (PEs) (respectively upper gastrointestinal bleedings (UGIBs)) following the THR with the numbers occurring during three unexposed periods one year later. This enabled us to estimate the odds ratio (OR) [95% confidence interval (CI)] for each of six successive 35-day intervals. The study included 108,099 patients. The ORs for PE were respectively 12.4 (95% CI, 8.6-17.8) (absolute risk difference rate per 100,000 (ARD/100,000)=130) and 5.0 (95% CI, 3.4-7.4) (ARD/100,000=52) for the first two 35-day intervals, and the risk was close to 1 thereafter. The risk of UGIB fell quickly, with an OR of 6.5 (95% CI, 4.6-9.1) (ARD/100,000=83) and 0.8 (95% CI, 0.4-1.6) for the first two 35-day intervals, respectively. The majority of UGIBs occurred during the inpatient stay for THR. Among middle-aged patients, the risk of a PE remains elevated beyond 35days after THR for coxarthrosis, whereas the risk of a UGIB remains elevated for the first 35days only.
Univ. Lille EA 2694, CHU Lille, Department of Public Health, F-59000 Lille, France. Electronic address: gregoire.ficheur@univ-lille2.fr.
Grégoire
G
Ficheur
Univ. Lille EA 2694, CHU Lille, Department of Public Health, F-59000 Lille, France.
Alexandre
A
Caron
Univ. Lille EA 2694, CHU Lille, Department of Geriatric Medicine, F-59000 Lille, France.
Jean-Baptiste
JB
Beuscart
CHU Lille, Department of Pharmacy, F-59000 Lille, France.
Laurie
L
Ferret
CHU Lille, Department of Orthopedic Surgery, F-59000 Lille, France.
Sophie
S
Putman
Univ. Lille EA 2694, CHU Lille, Department of Public Health, F-59000 Lille, France.
Régis
R
Beuscart
Univ. Lille EA 2694, CHU Lille, Department of Public Health, F-59000 Lille, France.
Emmanuel
E
Chazard
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015331:Cohort Studies; D018592:Cross-Over Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000517:prevention & control
Bleeding event; Patient safety; Total hip arthroplasty; Total hip replacement; Venous thromboembolic event