Related Experiment Video
Updated: Feb 5, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
A dedicated anticoagulation clinic does not improve postoperative management of warfarin after total joint
Joshua S Bingham1, Christopher G Salib1, Kyle Labban1
1Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA.
Background:
Periprosthetic joint infections (PJIs) are devastating complications. Excessive anticoagulation with warfarin is an independent risk factor for PJIs. The use of a dedicated anticoagulation clinic to improve warfarin management has not been proven.
Methods:
Between 2006 and 2014, we identified 92 patients who were placed on postoperative warfarin, and later developed PJI. These patients were compared to 313 patients who underwent total joint arthroplasty placed on warfarin without developing PJI. Patients were included if they had no history of a venous thromboembolic event, were warfarin naive, and enrolled in the anticoagulation clinic. A univariate analysis compared independent variables, and statistical analysis was performed using Student's t-test and Pearson chi-square test for continuous and categorical variables.
Results:
Thirty-six PJI patients and 297 control patients met the inclusion criteria. The venous thromboembolism rate was 2.1%. At discharge, 82% of all patients were subtherapeutic. Patients were within their target international normalized ratio (INR) range 26.7% of the time. The mean INR in the initial postoperative period for the PJI group was 1.46 and 1.29 in the control group (P < .001). In the acute postoperative period, 13.3% of the knee PJI group were therapeutic or supratherapeutic compared with 3.5% in the knee control group (P = .002).
Conclusions:
Despite utilization of a dedicated anticoagulation clinic, patients were only within their target INR range 27% of the time. Total knee arthroplasty patients who developed a PJI were more likely to be therapeutic or supratherapeutic in the initial postoperative period. Consequently, the risks associated with warfarin as a venous thromboembolism prophylaxis may outweigh the potential benefits.
Insights
Warfarin management for preventing periprosthetic joint infections (PJIs) after surgery is challenging. Even with anticoagulation clinics, patients often fall outside the target INR range, increasing PJI risk.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Pharmacology
Background:
- Periprosthetic joint infections (PJIs) are serious complications following joint replacement surgery.
- Excessive anticoagulation with warfarin is a known risk factor for developing PJIs.
- The efficacy of dedicated anticoagulation clinics in optimizing warfarin management for PJI prevention remains unproven.
Purpose of the Study:
- To evaluate the effectiveness of a dedicated anticoagulation clinic in managing warfarin therapy post-total joint arthroplasty.
- To determine the association between warfarin management, international normalized ratio (INR) control, and the incidence of PJIs.
- To compare warfarin management in patients who developed PJI versus those who did not.
Main Methods:
- A retrospective study identified patients on postoperative warfarin who developed PJI (n=36) and compared them to controls without PJI (n=297).
- Inclusion criteria included no prior venous thromboembolic events, warfarin naivety, and enrollment in an anticoagulation clinic.
- Univariate analysis, Student's t-test, and Pearson chi-square test were used for statistical comparisons.
Main Results:
- Patients spent only 26.7% of the time within their target INR range, despite clinic utilization.
- The mean INR in the initial postoperative period was significantly higher in the PJI group (1.46) compared to the control group (1.29).
- Knee PJI patients were more likely to have therapeutic or supratherapeutic INRs in the acute postoperative period (13.3%) than controls (3.5%).
Conclusions:
- Dedicated anticoagulation clinics did not consistently maintain patients within the target INR range (achieved 27% of the time).
- Total knee arthroplasty patients who developed PJI were more likely to have therapeutic or supratherapeutic INRs postoperatively.
- The potential benefits of warfarin for venous thromboembolism prophylaxis may be outweighed by the increased risk of PJI in certain patient populations.
More Related Videos
09:51The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
09:31Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...