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Mortality Risk Assessment of Total Knee Arthroplasty and Related Surgery After Percutaneous Coronary Intervention
Arvind G Von Keudell1, Thomas S Thornhill1, Jeffrey N Katz1
1Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery (EL, JNK), Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy (EL, JNK), Department of Orthopedic Surgery (AGvK, TST, JNK, EL), Brigham and Women's Hospital, Boston, MA, Massachusetts; Harvard Medical School, Boston, MA, Massachusetts (TST, JNK, EL); Department of Epidemiology, Harvard School of Public Health (JNK), Department of Biostatistics, Boston University School of Public Health, Boston, MA, Massachusetts (EL), USA.
Insights
Discontinuing antiplatelet therapy (APT) after coronary artery stenting (CAS) for knee surgery increases mortality risk. Continuous APT use is safer, reducing 30-day post-surgery deaths significantly.
Area of Science:
- Cardiology
- Surgical Outcomes
- Pharmacology
Background:
- Optimal antiplatelet therapy (APT) strategy post-Coronary Artery Stenting (CAS) for non-cardiac surgery, like total knee arthroplasty (TKA), is not well-defined.
- Managing APT perioperatively after CAS presents a clinical challenge.
Purpose of the Study:
- To evaluate the mortality outcomes of continuous APT versus discontinuation after CAS in patients undergoing TKA.
- To inform clinical decision-making regarding APT management in this patient population.
Main Methods:
- A decision tree model was developed to analyze mortality.
- Two APT strategies were compared: continuous use and discontinuation.
- Outcomes were assessed for patients undergoing TKA after CAS.
Main Results:
- Discontinuing APT within the first month post-CAS resulted in a 10.5% 30-day mortality after TKA.
- Continuous APT use showed a significantly lower 30-day post-TKA mortality of 1.0%.
- Mortality rates decreased for both strategies with longer intervals between CAS and surgery.
Conclusions:
- Discontinuation of APT following CAS may increase 30-day mortality for TKA patients up to one year post-procedure.
- Continuous APT is associated with better survival outcomes in the perioperative period after CAS for TKA.
- The findings suggest a need for revised guidelines on APT management in patients undergoing non-cardiac surgery post-CAS.
Background:
The optimal antiplatelet therapy (APT) treatment strategy after Coronary Artery Stenting (CAS) in non-cardiac surgery, such as total knee arthroplasty (TKA) or urgent TKA-related surgery remains unknown.
Methods:
We built a decision tree model to examine the mortality outcomes of two alternative strategies for APT after CAS use in the perioperative period namely, continuous use and discontinuation.
Results:
If surgery was performed in the first month after CAS placement, discontinuing APT led to an estimated 30-day post TKA mortality of 10.5%, compared to 1.0% in a strategy with continuous APT use. Mortality with both strategies decreased with longer intervals.
Conclusion:
Our model demonstrated that APT discontinuation in patients undergoing TKA or urgent TKA related surgery after CAS placement might lead to greater 30-day mortality up to one year.
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