Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty

Aug 29, 2018The Journal of the American Academy of Orthopaedic Surgeons

Changes in Blood Clot Prevention and Clot Rates After Hip and Knee Replacement Surgery

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Abstract

A total of 369,483 patients were analyzed for deep vein thrombosis (DVT) risk after total hip and knee arthroplasties.

Warfarin was the most commonly prescribed anticoagulant among patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Patients with a hypercoagulable diagnosis had a significantly higher incidence of DVT within 6 months post-surgery.
Those treated with warfarin or enoxaparin had a higher likelihood of developing DVT compared to patients treated with aspirin, fondaparinux, or rivaroxaban.
A multivariate regression analysis indicated that aspirin, fondaparinux, and rivaroxaban were associated with a markedly lower risk of DVT compared to warfarin or enoxaparin.

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INTRODUCTION: Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are at high risk of deep vein thrombosis (DVT) postoperatively, necessitating the use of prophylaxis medications. This investigation used a large claims database to evaluate trends in postoperative DVT prophylaxis and rates of DVT within 6 months after THA or TKA.

METHODS: Truven Health MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases were reviewed from 2004 to 2013 for patients who underwent THA or TKA. Data were collected on patient age, sex, Charlson Comorbidity Index, and hypercoagulability diagnoses. Postoperative medication claims were reviewed for prescribed aspirin, warfarin, enoxaparin, fondaparinux, rivaroxaban, and dabigatran.

RESULTS: A total of 369,483 patients were included in the analysis, of which 239,949 patients had prescription medication claims. Warfarin was the most commonly prescribed anticoagulant. Patients with a hypercoagulable diagnosis had markedly more DVTs within 6 months after THA or TKA. More patients with a hypercoagulable diagnosis were treated with warfarin or lovenox than other types of anticoagulants. A multivariate regression analysis was performed, showing that patients prescribed aspirin, fondaparinux, and rivaroxaban were markedly less likely than those prescribed warfarin or enoxaparin to have a DVT within 6 months after THA or TKA.

CONCLUSION: After THA and TKA, warfarin is the most commonly prescribed prophylaxis. Patients with hypercoagulability diagnoses are at a higher risk of postoperative DVT. The likelihood of DVT within 6 months of THA and TKA was markedly higher in patients treated with warfarin and lovenox and markedly lower in those treated with aspirin, fondaparinux, and rivaroxaban.

LEVEL OF EVIDENCE: Level III.

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Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty

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