Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty

• Published in: Journal of orthopaedic surgery and research Vol. 10; no. 1; p. 145
• Main Authors: Haighton, Martijn, Kempen, Diederik H R, Wolterbeek, Nienke, Marting, Louis N, van Dijk, Martijn, Veen, Remmelt M R
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17-09-2015; BioMed Central
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants (Medicine); Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Care and treatment; Cohort Studies; Complications and side effects; Drug Administration Schedule; Female; Health aspects; Heparin, Low-Molecular-Weight - administration & dosage; Heparin, Low-Molecular-Weight - adverse effects; Humans; Male; Medical research; Medicine, Experimental; Middle Aged; Orthopedics; Postoperative Hemorrhage - chemically induced; Postoperative Hemorrhage - diagnosis; Retrospective Studies; Risk Factors; Thromboembolism; Thromboembolism - chemically induced; Thromboembolism - diagnosis
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-015-0285-6

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.
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.
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.
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.