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Published on: February 28, 2012
Anticoagulation in patients with atrial fibrillation undergoing inpatient total knee arthroplasty: A matched analysis
Mohammad Daher1, Mariah Balmaceno-Criss1, Jonathan Liu1
1Department of Orthopedics, Brown University, Providence, RI, USA.
Insights
Patients with atrial fibrillation (AF) on anticoagulants like Warfarin or DOACs face increased post-operative complications after total knee arthroplasty (TKA). This highlights risks associated with anticoagulant use in TKA patients.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Pharmacology
Background:
- Atrial fibrillation (AF) necessitates lifelong anticoagulation with Warfarin or Direct-acting Oral Anticoagulants (DOACs).
- Assessing post-operative complications in AF patients undergoing total knee arthroplasty (TKA) is crucial.
Purpose of the Study:
- To evaluate the impact of pre-existing anticoagulant use on post-operative complications in AF patients undergoing TKA.
- To compare complication rates between patients on Warfarin, DOACs, and control groups.
Main Methods:
- Retrospective analysis of the PearlDiver database for inpatient TKA procedures.
- Matching AF patients on Warfarin or DOACs with control cohorts.
- Comparison of medical and surgical complications at 30 and 90 days post-operatively.
Main Results:
- Anticoagulated patients (Warfarin/DOAC) showed higher rates of AKI, pneumonia, MI, transfusion, sepsis, and aseptic loosening.
- Pulmonary embolism (PE) and hematoma were elevated in the Warfarin group; TKA instability in the DOAC group.
- Control groups had more wound dehiscence and higher rates of revision surgery.
Conclusions:
- Anticoagulant use (Warfarin and DOACs) in AF patients undergoing TKA is associated with increased post-operative complications.
- Specific complications varied between Warfarin and DOAC users.
- Understanding these risks is vital for managing AF patients undergoing TKA.
Background:
Patients with atrial fibrillation (AF) often require lifetime anticoagulation using drugs such as Warfarin and Direct-acting Oral Anticoagulants (DOAC). It is important to assess the impact that prior anticoagulant use has on the post-operative complications in patients with AF undergoing TKA.
Methods:
This is a retrospective analysis of the PearlDiver database querying all patients who underwent an inpatient TKA. Patients who had AF and filled a prescription for at least 30 days of either Warfarin or a DOAC were matched to control cohorts. Medical and surgical complications 30 and 90 days post-operatively were compared between the two groups.
Results:
4396 patients made up the group with AF on warfarin, while 5383 patients made up the cohort with AF on DOAC and their corresponding controls. Patients on anticoagulation had more AKI (OR 2.70, OR: 2.37), pneumonia (OR: 2.89, OR: 2.46), MI (OR: 2.70, OR: 3.14), transfusion (OR: 6.94, OR: 3.16), sepsis (OR: 2.47, OR: 1.96), and aseptic loosening at 90 days (OR: 17.06, OR:7.01). However, PE (OR: 3.32) and hematoma (OR: 1.71) were only higher in the warfarin cohort. TKA instability was higher in the DOAC cohort (OR: 6.00). Conversely, patients in the control group exhibited more wound dehiscence compared to the warfarin group (OR: 0.28), and higher rates of revision surgery compared to both the DOAC (OR:0.27) and Warfarin (OR:0.31) groups at 90 days.
Conclusion:
Patients on DOAC and Warfarin for AF, and undergoing TKA are exposed to a higher risk of post-operative complications.
