Ninety-Day Morbidity in Patients Undergoing Primary TKA With Discontinuation of Warfarin and Bridging With LMWH
Abstract We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired...
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| Veröffentlicht in: | The Journal of arthroplasty 2014-06, Vol.29 (6), p.1185-1188 |
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| container_title | The Journal of arthroplasty |
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| creator | Gibon, Emmanuel, MD Barut, Nicolas, MD Anract, Phillipe, MD Courpied, Jean-Pierre, MD Hamadouche, Moussa, MD, PhD |
| description | Abstract We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA. |
| doi_str_mv | 10.1016/j.arth.2013.12.029 |
| format | Article |
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We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2013.12.029</identifier><identifier>PMID: 24468534</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anticoagulants - adverse effects ; Arthroplasty, Replacement, Knee - adverse effects ; Blood Transfusion ; bridging therapy ; Comorbidity ; complications ; Female ; Hematoma - etiology ; Hemorrhage - etiology ; Heparin, Low-Molecular-Weight - adverse effects ; Humans ; Length of Stay ; Male ; Morbidity ; Orthopedics ; Postoperative Complications - epidemiology ; re-operations ; Reoperation ; Retrospective Studies ; TKA ; warfarin ; Warfarin - adverse effects</subject><ispartof>The Journal of arthroplasty, 2014-06, Vol.29 (6), p.1185-1188</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-5b42a08765ed80ef2a62b8e1e510bf65b4974c92fb1aa1f0423fd8453d13cd9a3</citedby><cites>FETCH-LOGICAL-c411t-5b42a08765ed80ef2a62b8e1e510bf65b4974c92fb1aa1f0423fd8453d13cd9a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S088354031300939X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24468534$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gibon, Emmanuel, MD</creatorcontrib><creatorcontrib>Barut, Nicolas, MD</creatorcontrib><creatorcontrib>Anract, Phillipe, MD</creatorcontrib><creatorcontrib>Courpied, Jean-Pierre, MD</creatorcontrib><creatorcontrib>Hamadouche, Moussa, MD, PhD</creatorcontrib><title>Ninety-Day Morbidity in Patients Undergoing Primary TKA With Discontinuation of Warfarin and Bridging With LMWH</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Abstract We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Blood Transfusion</subject><subject>bridging therapy</subject><subject>Comorbidity</subject><subject>complications</subject><subject>Female</subject><subject>Hematoma - etiology</subject><subject>Hemorrhage - etiology</subject><subject>Heparin, Low-Molecular-Weight - adverse effects</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Morbidity</subject><subject>Orthopedics</subject><subject>Postoperative Complications - epidemiology</subject><subject>re-operations</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>TKA</subject><subject>warfarin</subject><subject>Warfarin - adverse effects</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAURi0EokPhBVggL9kk9fVPJpEQUmmhRUyhEq2GneXYztTDjF1sBylvj8MUFixYeXHP98n3XIReAqmBQHOyrVXMdzUlwGqgNaHdI7QAwWjVctI8RgvStqwSnLAj9CylLSEAQvCn6Ihy3rSC8QUKn523earO1YSvQuydcXnCzuNrlZ31OeFbb2zcBOc3-Dq6vYoTvvl0itcu3-Fzl3Tw2fmx0MHjMOC1ioOKpUB5g99FZzZz8je9ulpfPkdPBrVL9sXDe4xuP7y_ObusVl8uPp6drirNAXIlek4VaZeNsKYldqCqoX1rwQog_dCUcbfkuqNDD0rBQDhlg2m5YAaYNp1ix-j1ofc-hh-jTVnuy1_tbqe8DWOSIGjL2LLreEHpAdUxpBTtIO8Pe0ogchYtt3IWLWfREqgsokvo1UP_2O-t-Rv5Y7YAbw6ALVv-dDbKpItQbY2LVmdpgvt__9t_4nrnvNNq991ONm3DGH3xJ0GmEpBf51PPlwZGSMe6b-wX4DGkFw</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Gibon, Emmanuel, MD</creator><creator>Barut, Nicolas, MD</creator><creator>Anract, Phillipe, MD</creator><creator>Courpied, Jean-Pierre, MD</creator><creator>Hamadouche, Moussa, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Ninety-Day Morbidity in Patients Undergoing Primary TKA With Discontinuation of Warfarin and Bridging With LMWH</title><author>Gibon, Emmanuel, MD ; Barut, Nicolas, MD ; Anract, Phillipe, MD ; Courpied, Jean-Pierre, MD ; Hamadouche, Moussa, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-5b42a08765ed80ef2a62b8e1e510bf65b4974c92fb1aa1f0423fd8453d13cd9a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Blood Transfusion</topic><topic>bridging therapy</topic><topic>Comorbidity</topic><topic>complications</topic><topic>Female</topic><topic>Hematoma - etiology</topic><topic>Hemorrhage - etiology</topic><topic>Heparin, Low-Molecular-Weight - adverse effects</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Morbidity</topic><topic>Orthopedics</topic><topic>Postoperative Complications - epidemiology</topic><topic>re-operations</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>TKA</topic><topic>warfarin</topic><topic>Warfarin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gibon, Emmanuel, MD</creatorcontrib><creatorcontrib>Barut, Nicolas, MD</creatorcontrib><creatorcontrib>Anract, Phillipe, MD</creatorcontrib><creatorcontrib>Courpied, Jean-Pierre, MD</creatorcontrib><creatorcontrib>Hamadouche, Moussa, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gibon, Emmanuel, MD</au><au>Barut, Nicolas, MD</au><au>Anract, Phillipe, MD</au><au>Courpied, Jean-Pierre, MD</au><au>Hamadouche, Moussa, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ninety-Day Morbidity in Patients Undergoing Primary TKA With Discontinuation of Warfarin and Bridging With LMWH</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>29</volume><issue>6</issue><spage>1185</spage><epage>1188</epage><pages>1185-1188</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Abstract We asked whether patients under long-term warfarin and managed with current guidelines regarding bridging therapy have a higher complications rate within ninety days following total knee arthroplasty. We retrospectively identified 38 patients under long-term warfarin. They were match-paired with 76 control patients. Our results showed a significant increased rate of complications (42.1% vs. 6.9%, P < 0.001) and re-operation (21.1% vs. 5.2%, P < 0.001) in the warfarin group. The difference was related to the number of hematomas requiring surgical evacuation. The warfarin group had a significantly higher rate of blood loss, blood transfusion, and length of hospital stay. Our data suggest that current guidelines for preoperative warfarin management are associated with a high rate of bleeding complications and reoperations following TKA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24468534</pmid><doi>10.1016/j.arth.2013.12.029</doi><tpages>4</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Anticoagulants - adverse effects Arthroplasty, Replacement, Knee - adverse effects Blood Transfusion bridging therapy Comorbidity complications Female Hematoma - etiology Hemorrhage - etiology Heparin, Low-Molecular-Weight - adverse effects Humans Length of Stay Male Morbidity Orthopedics Postoperative Complications - epidemiology re-operations Reoperation Retrospective Studies TKA warfarin Warfarin - adverse effects |
| title | Ninety-Day Morbidity in Patients Undergoing Primary TKA With Discontinuation of Warfarin and Bridging With LMWH |
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