Related Experiment Video
Updated: Apr 5, 2026
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Opportunities for improvement: anticoagulation in patients undergoing total knee or hip replacement
Mads Thorsberger1, Thomas Jensen2, Jonas Olesen2
1Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. mads.thorsberger@gmail.com.
Insights
Pharmacological thromboprophylaxis use after knee or hip replacement was low but increased significantly from 2008-2011. Increased availability of novel oral anticoagulants likely drove this trend, warranting further initiatives for guideline adherence.
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Public Health
Background:
- Guidelines recommend pharmacological thromboprophylaxis after total knee or hip replacement for improved outcomes.
- Clinical practice adherence to these thromboprophylaxis guidelines is not well-documented.
Purpose of the Study:
- To assess the utilization of pharmacological thromboprophylaxis post-discharge following total knee or hip replacement.
- To identify factors associated with the initiation of thromboprophylaxis in this patient population.
Main Methods:
- A nationwide cohort study included 50,389 patients undergoing first-time total knee or hip replacement in Denmark (2008-2011).
- Anticoagulant use (oral and subcutaneous) was determined by claimed prescriptions post-discharge.
- Logistic regression analysis identified factors influencing prophylaxis initiation.
Main Results:
- Pharmacological thromboprophylaxis was initiated in 17% of patients (14.7% novel oral anticoagulants, 2.3% heparins/fondaparinux).
- Anticoagulant use rose from 6.3% in 2008 to 30.0% in 2011.
- Increased age and female gender were associated with higher prophylaxis rates in hip replacement patients.
Conclusions:
- Pharmacological thromboprophylaxis use after joint replacement surgery was low but increasing, likely due to novel oral anticoagulant availability.
- Further initiatives are needed to promote guideline-recommended prophylactic anticoagulation in orthopedic surgery patients.
Background:
According to guidelines, initiation of pharmacological thromboprophylaxis after total knee or hip replacement is recommended and associated with improved patient outcomes. However, data on how these recommendations are followed in clinical practice are sparse.
Methods:
All patients undergoing first-time total knee or hip replacement in Denmark 2008-2011 were identified. By cross-referencing Danish nationwide registries, quantitative use of anticoagulants administered orally and subcutaneously post-discharge was assessed by number of claimed prescriptions after surgery. Logistic regression analysis was used to identify factors associated with initiation of prophylaxis.
Results:
A total of 50,389 patients were included in the study (median age 69, inter-quartile range 62-76). Novel oral anticoagulants were initiated in 14.7 % of the patients and heparins/fondaparinux in 2.3 % of the patients. The use of anticoagulants increased from 6.3 % in 2008 to 30.0 % of patients in 2011. Among patients initiating prophylaxis with a novel oral anticoagulant post-discharge, almost all were treated according to guidelines in terms of treatment duration. Factors significantly associated with an increased chance of prophylaxis among total hip replacement patients were: age (per 10-year increments) and female gender.
Conclusions:
Use of pharmacological thromboprophylaxis after total knee or hip replacement was low, but increasing during the study period. This is probably due to increased availability of novel oral anticoagulants. Further initiatives to increase guideline recommended use of prophylactic anticoagulation after orthopaedic surgery are warranted.
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