Arthroplasty wound complications linked to oral anticoagulant use

By Lynda Williams, senior medwireNews Reporter

Multicenter research suggests that recovery from hip or knee arthroplasty may be significantly affected by choice of pharmaceutical thromboprophylaxis.

Pooled data from eight hospitals in England shows that patients given low molecular weight heparin (LMWH) had a significantly lower rate of wound complications in the 30 days after surgery than those treated with the oral anticoagulant rivaroxaban, at 2.81% versus 3.86% and an odds ratio (OR) of 0.72.

The rate of return to surgery to treat wound complications did not significantly differ by treatment, but patients with wound complications ‑ defined as hematoma or superficial or deep infection ‑ had a significantly longer stay on average than those without, at 14.2 versus 6.6 days.

However, patients given rivaroxaban were significantly less likely to develop symptomatic deep vein thrombosis than their LMWH-treated counterparts (0.23 vs 0.91%), report Simon Jameson (James Cook University Hospital, Middlesbrough, UK) and co-authors.

The 2762 rivaroxaban-treated patients and 10,361 LMWH-treated patients did not significantly differ in 30-day rates of symptomatic pulmonary embolism, all-cause mortality, or readmission to hospital. There was a trend toward fewer episodes of major bleeding with LMWH than rivaroxaban, but this did not reach significance.

Writing in the US edition of the Journal of Bone and Joint Surgery, the researchers explain that rivaroxaban was recommended for use in UK hospitals by the National Institute for Health and Clinical Excellence on the basis the agent offers equal thromboprophylaxis to LMWH without the need for injections or close monitoring.

But the authors state that the reduction in costs associated with rivaroxaban administration does not offset the increased cost of wound complication care with the oral anticoagulant compared with LMWH.

Jameson et al note that surgical site hemorrhage and other wound complications can adversely affect function and impact the need for transfusion, reoperation, and revision surgery, while deep vein thrombosis has been reported to have long-term sequelae.

"Longer follow-up is needed to assess any potential relationship between wound complications and joint stiffness, latent infection, and limb consequences of deep venous thrombosis," they conclude.

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