Clinical Orthopaedics and Related Research

, Volume 466, Issue 3, pp 714–721

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

  • Nigel E. Sharrock
  • Alejandro Gonzalez Della Valle
  • George Go
  • Stephen Lyman
  • Eduardo A. Salvati
Original Article


Anticoagulation for thromboprophylaxis after THA and TKA has not been confirmed to diminish all-cause mortality. We determined whether the incidence of all-cause mortality and pulmonary embolism in patients undergoing total joint arthroplasty differs with currently used thromboprophylaxis protocols. We reviewed articles published from 1998 to 2007 that included 6-week or 3-month incidence of all-cause mortality and symptomatic, nonfatal pulmonary embolism. Twenty studies included reported 15,839 patients receiving low-molecular-weight heparin, ximelagatran, fondaparinux, or rivaroxaban (Group A); 7193 receiving regional anesthesia, pneumatic compression, and aspirin (Group B); and 5006 receiving warfarin (Group C). All-cause mortality was higher in Group A than in Group B (0.41% versus 0.19%) and the incidence of clinical nonfatal pulmonary embolus was higher in Group A than in Group B (0.60% versus 0.35%). The incidences of all-cause mortality and nonfatal pulmonary embolism in Group C were similar to those in Group A (0.4 and 0.52, respectively). Clinical pulmonary embolus occurs despite the use of anticoagulants. Group A anticoagulants were associated with the highest all-cause mortality of the three modalities studied.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Nigel E. Sharrock
    • 1
  • Alejandro Gonzalez Della Valle
    • 2
  • George Go
    • 1
  • Stephen Lyman
    • 3
  • Eduardo A. Salvati
    • 2
  1. 1.Department of AnesthesiologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA
  3. 3.Foster Center for Clinical Outcome ResearchHospital for Special SurgeryNew YorkUSA

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