Coagulopathies may be associated with adverse events after THA, TKA
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Coagulopathies such as low platelet counts, lengthy partial thromboplastin time and a high international normalized ratio may be risk factors for adverse events following total hip and knee arthroplasties, according to published results.
Researchers from the department of orthopedics and rehabilitation at the Yale School of Medicine used the American College of Surgeons National Surgical Quality Improvement Program database to identify 39,605 patients who underwent THA and 67,685 patients who underwent TKA from 2011 to 2015.
According to the study, the researchers assessed the patients for coagulopathy data such as platelet count, partial thromboplastin time (PTT) and international normalized ratio (INT), with approximately 16% of patients presenting with a coagulopathy. Researchers also performed univariate and multivariate analyses to find any correlations between coagulopathies and adverse events (AEs) at 30 days postoperatively.
For patients who underwent THA, low platelets, high PTT and high INR were found to increase odds of AEs, and low platelets and high INR were also associated with increased odds of AEs in the TKA cohort. Researchers also noted that high PTT was the coagulopathy most associated with major AEs and readmissions.
“With the higher rates of readmissions and postoperative complications in this at-risk patient population, these results suggest that greater perioperative medical optimization and post-discharge care may be able to lower the risks of readmissions in this group, thereby reducing cost and improving care metrics,” the researchers wrote in the study. “These findings also suggest that preoperative laboratory values can in fact be useful in evaluating patients for THA and TKA and inform postoperative management,” they added.
Perspective
Back to TopYale A. Fillingham, MD, and Jess H. Lonner, MD
Preoperative coagulopathy is a surrogate for risk of blood loss, which is known to be associated with postoperative adverse events related to bleeding, such as wound drainage and infection, among others. Therefore, the authors’ results intuitively are informative but unsurprising. We should note the study period of 2011 to 2015 covers the time period tranexamic acid (TXA) was beginning to gain broader adoption in total joint arthroplasty.
Because TXA is highly effective at reducing blood loss and its use has become nearly universal in TJA since the study period, it leaves us wondering if the results are representative of current arthroplasty outcomes. We encourage further study of this patient cohort using current TXA protocols.
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