Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement?: A retrospective cohort study

Fraser Todd; Daniel Yeomans; Michael R Whitehouse; Gulraj Matharu

doi:10.1016/j.jor.2021.05.030

Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement? A retrospective cohort study

Fraser Todd^*, Daniel Yeomans^*, Michael R Whitehouse^*, Gulraj Matharu^*

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

3 Citations (Scopus)

31 Downloads (Pure)

Abstract

Background The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR. Materials and methods We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed. Results The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644). Conclusions Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/− LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.

Original language	English
Pages (from-to)	301-304
Number of pages	4
Journal	Journal of Orthopaedics
Volume	25
Early online date	25 May 2021
DOIs	https://doi.org/10.1016/j.jor.2021.05.030
Publication status	Published - 19 Jun 2021

Bibliographical note

Funding Information:
MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England, Clinical Research Fellowship awarded from Arthritis Research UK, Research Grants from The Orthopaedics Trust, and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare.

Funding Information:
MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England , Clinical Research Fellowship awarded from Arthritis Research UK , Research Grants from The Orthopaedics Trust , and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare.

Publisher Copyright:
© 2021

Keywords

Venous thromboembolism
Thromboprophylaxis
Total hip replacement
Total knee replacement
Wound complication

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10.1016/j.jor.2021.05.030

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@article{969e82f5b10549ef8aa56e6569244bb4,

title = "Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement?: A retrospective cohort study",

abstract = "Background The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR. Materials and methods We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed. Results The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644). Conclusions Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/− LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.",

keywords = "Venous thromboembolism, Thromboprophylaxis, Total hip replacement, Total knee replacement, Wound complication",

author = "Fraser Todd and Daniel Yeomans and Whitehouse, {Michael R} and Gulraj Matharu",

note = "Funding Information: MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England, Clinical Research Fellowship awarded from Arthritis Research UK, Research Grants from The Orthopaedics Trust, and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare. Funding Information: MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England , Clinical Research Fellowship awarded from Arthritis Research UK , Research Grants from The Orthopaedics Trust , and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare. Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = jun,

day = "19",

doi = "10.1016/j.jor.2021.05.030",

language = "English",

volume = "25",

pages = "301--304",

journal = "Journal of Orthopaedics",

issn = "0972-978X",

publisher = "Elsevier",

}

Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement? A retrospective cohort study. / Todd, Fraser; Yeomans, Daniel; Whitehouse, Michael R et al.
In: Journal of Orthopaedics, Vol. 25, 19.06.2021, p. 301-304.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement?

T2 - A retrospective cohort study

AU - Todd, Fraser

AU - Yeomans, Daniel

AU - Whitehouse, Michael R

AU - Matharu, Gulraj

N1 - Funding Information: MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England, Clinical Research Fellowship awarded from Arthritis Research UK, Research Grants from The Orthopaedics Trust, and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare. Funding Information: MW declares fees paid for presentations for the companies DePuy and Heraeus (funds paid to institution for postgraduate teaching), financial support as a principle investigator from Stryker, DePuy, Heraues, JRI and CeramTec and other financial or material support from Stryker, DePuy, Heraues, JRI, CeramTec. They also declare royalties from Taylor and Francis for editing of Orthopaedic textbook and the following committee appointments: Associate Editor of Hip International, Editorial board Bone Joint Journal EFORT Basic Science task force committee member, British Orthopaedic Association Research Committee, British Hip Society Research Committee. GM declares medicolegal work for Leigh Day and financial support from the following as principle investigator: Surgical Research Fellowship awarded from The Royal College of Surgeons of England , Clinical Research Fellowship awarded from Arthritis Research UK , Research Grants from The Orthopaedics Trust , and The Royal Orthopaedic Hospital Hip Fund and The Academy of Medical Sciences Starter Grants for Clinical Lecturers. Both FT and DY have no conflicting interests to declare. Publisher Copyright: © 2021

PY - 2021/6/19

Y1 - 2021/6/19

N2 - Background The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR. Materials and methods We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed. Results The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644). Conclusions Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/− LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.

AB - Background The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR. Materials and methods We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed. Results The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644). Conclusions Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/− LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.

KW - Venous thromboembolism

KW - Thromboprophylaxis

KW - Total hip replacement

KW - Total knee replacement

KW - Wound complication

U2 - 10.1016/j.jor.2021.05.030

DO - 10.1016/j.jor.2021.05.030

M3 - Article (Academic Journal)

C2 - 34140759

SN - 0972-978X

VL - 25

SP - 301

EP - 304

JO - Journal of Orthopaedics

JF - Journal of Orthopaedics

ER -