Association between duration of anticoagulant thromboprophylaxis and revision rate in primary total hip arthroplasty: a Danish and Norwegian nationwide cohort study

Dennis Vinther; Aurelie Mailhac; Ina Trolle Andersen; Søren Overgaard; Stein Atle Lie; Anne Marie Fenstad; Jan-Erik Gjertsen; Ove Furnes; Alma B Pedersen

doi:10.2340/17453674.2022.6243

Authors

Dennis Vinther Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus https://orcid.org/0000-0003-4453-3725
Aurelie Mailhac Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus https://orcid.org/0000-0002-5606-0139
Ina Trolle Andersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus https://orcid.org/0000-0002-8140-1548
Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, and The Danish Hip Arthroplasty Register; Department of Clinical Medicine, Faculty of Health and Medical Sciences Register, Copenhagen, Denmark https://orcid.org/0000-0001-6829-4787
Stein Atle Lie The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Dentistry, University of Bergen, Bergen
Anne Marie Fenstad The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen https://orcid.org/0000-0002-6429-0153
Jan-Erik Gjertsen The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway https://orcid.org/0000-0002-8490-268X
Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway https://orcid.org/0000-0001-8223-2515
Alma B Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus https://orcid.org/0000-0002-3288-9401

DOI:

https://doi.org/10.2340/17453674.2022.6243

Keywords:

Arthroplasty, Hip, Implants, Revision, Thromboprophylaxis

Abstract

Background and purpose: There are concerns that bleeding following primary total hip arthroplasty (THA) contributes to prolonged wound drainage and prosthetic joint infection (PJI). We examined whether short (1–5 days), medium (6–14 days), and extended (≥ 15 days) duration of thromboprophylaxis is associated with the 5-year revision rate after THA due to osteoarthritis.
Patients and methods: We performed a cohort study based on data from hip arthroplasty and administrative registries in Denmark and Norway (2008–2014). The outcome was revision surgery due to PJI, aseptic loosening or any cause, and patient mortality. Adjusted cause-specific hazard ratios (HRs) were analyzed with Cox regression analyses.
Results: Among 50,482 THA patients, 8,333 received short, 17,009 received medium, and 25,140 received extended thromboprophylaxis. The HRs for revision due to PJI within 5 years were 1.0 (95%CI 0.7–1.3) and 1.1 (CI 0.9–1.3) for short and extended vs. medium treatment, whereas HR for extended vs. medium prophylaxis was 1.5 (CI 1.2–2.0) within 3 months. The HRs for revision due to aseptic loosening within 5 years were 1.0 (CI 0.7–1.4) and 1.1 (CI 0.9–1.4) for short and extended vs. medium treatment. The HRs for any revision within 5 years were 0.9 (CI 0.8–1.1) and 0.9 (CI 0.8–1.0) for short and extended vs. medium treatment. Extended vs. medium prophylaxis was associated with a decreased 0–3 month mortality. The absolute differences at 5 years were ≤ 1%.
Conclusion: Our data suggests no association between duration of anticoagulant thromboprophylaxis and revision rate within 5 years of primary THA. The extended thromboprophylaxis might be associated with early increased revision rate due to PJI but also with lower mortality; however, the clinical relevance of this finding requires further research.