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

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Clinical Orthopaedics and Related Research

Abstract

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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Authors and Affiliations

  1. Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Nigel E. Sharrock BMedSci, MB, ChB & George Go BS

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Alejandro Gonzalez Della Valle MD & Eduardo A. Salvati MD

  3. Foster Center for Clinical Outcome Research, Hospital for Special Surgery, New York, NY, USA

    Stephen Lyman PhD

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  1. Nigel E. Sharrock BMedSci, MB, ChB
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  2. Alejandro Gonzalez Della Valle MD
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  3. George Go BS
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  4. Stephen Lyman PhD
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  5. Eduardo A. Salvati MD
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Correspondence to Nigel E. Sharrock BMedSci, MB, ChB.

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Sharrock, N.E., Gonzalez Della Valle, A., Go, G. et al. Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty. Clin Orthop Relat Res 466, 714–721 (2008). https://doi.org/10.1007/s11999-007-0092-4

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  • DOI: https://doi.org/10.1007/s11999-007-0092-4

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