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Chronic Anticoagulation is Associated With Significantly Increased Rates of Medical Complications, Periprosthetic

Rahul K Goel1,2, Bailey J Ross1, Kevin Y Heo1

  • 1Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.

Arthroplasty Today
|July 2, 2025
PubMed

Insights

Patients on chronic anticoagulation (CA) face higher risks of complications, including sepsis, infection, and revision surgery, after total knee arthroplasty (TKA). Careful preoperative and perioperative management is crucial for this growing patient group.

Area of Science:

  • Orthopedic Surgery
  • Pharmacology
  • Public Health

Background:

  • The number of patients requiring total knee arthroplasty (TKA) while on chronic anticoagulation (CA) is rising.
  • Limited research exists on the complication rates associated with TKA in patients on CA.

Purpose of the Study:

  • To compare complication rates after primary TKA between patients on chronic anticoagulation (CA) and those not on CA.

Main Methods:

  • A retrospective cohort study utilized IBM MarketScan databases.
  • Patients undergoing primary TKA were divided into CA and control groups based on anticoagulant use.
  • Complication rates (readmissions, medical complications, PJI, revision) were compared using multivariable logistic regression.

Main Results:

  • The CA cohort (7.7% of 181,760 patients) showed significantly higher rates of sepsis, hematoma, wound dehiscence, and readmission within 90 days.
  • At 2 years, the CA cohort had significantly higher rates of periprosthetic joint infection (PJI) and all-cause revision.

Conclusions:

  • Chronic anticoagulation (CA) is linked to increased risks of readmission, medical complications, PJI, and revision after primary TKA.
  • Preoperative medical optimization and perioperative management are critical for patients on CA undergoing TKA.
Abstract

Keywords:
ComplicationsPerioperative managementTotal knee arthroplasty

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