TY - JOUR

T1 - Thromboembolic and bleeding complications following primary total knee arthroplasty A DANISH NATIONWIDE COHORT STUDY

AU - Schelde, A. B.

AU - Petersen, J.

AU - Jensen, T. B.

AU - Gromov, K.

AU - Overgaard, S.

AU - Olesen, J. B.

AU - Jimenez-Solem, E.

PY - 2021

Y1 - 2021

N2 - AimsThe aim of this study is to compare the effectiveness and safety of thromboprophylactic treatments in patients undergoing primary total knee arthroplasty (TKA).MethodsUsing nationwide medical registries, we identified patients with a primary TKA performed in Denmark between 1 January 2013 and 31 December 2018 who received thromboprophylactic treatment. We examined the 90-day risk of venous thromboembolism (VTE), major bleeding, and all-cause mortality following surgery. We used a Cox regression model to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome, pairwise comparing treatment with dalteparin or dabigatran with rivaroxaban as the reference. The HRs were both computed using a multivariable and a propensity score matched analysis.ResultsWe identified 27,736 primary TKA patients who received thromboprophylactic treatment (rivaroxaban (n = 18,846); dalteparin (n = 5,767); dabigatran (n = 1,443); tinzaparin (n = 1,372); and enoxaparin (n = 308)). In the adjusted multivariable analysis and compared with rivaroxaban, treatment with dalteparin (HR 0.68 (95% CI 0.49 to 0.92)) or dabigatran (HR 0.31 (95% CI 0.13 to 0.70)) was associated with a decreased risk of VTE. No statistically significant differences were observed for major bleeding or all-cause mortality. The propensity score matched analysis yielded similar results.ConclusionTreatment with dalteparin or dabigatran was associated with a decreased 90-day risk of VTE following primary TKA surgery compared with treatment with rivaroxaban.

AB - AimsThe aim of this study is to compare the effectiveness and safety of thromboprophylactic treatments in patients undergoing primary total knee arthroplasty (TKA).MethodsUsing nationwide medical registries, we identified patients with a primary TKA performed in Denmark between 1 January 2013 and 31 December 2018 who received thromboprophylactic treatment. We examined the 90-day risk of venous thromboembolism (VTE), major bleeding, and all-cause mortality following surgery. We used a Cox regression model to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome, pairwise comparing treatment with dalteparin or dabigatran with rivaroxaban as the reference. The HRs were both computed using a multivariable and a propensity score matched analysis.ResultsWe identified 27,736 primary TKA patients who received thromboprophylactic treatment (rivaroxaban (n = 18,846); dalteparin (n = 5,767); dabigatran (n = 1,443); tinzaparin (n = 1,372); and enoxaparin (n = 308)). In the adjusted multivariable analysis and compared with rivaroxaban, treatment with dalteparin (HR 0.68 (95% CI 0.49 to 0.92)) or dabigatran (HR 0.31 (95% CI 0.13 to 0.70)) was associated with a decreased risk of VTE. No statistically significant differences were observed for major bleeding or all-cause mortality. The propensity score matched analysis yielded similar results.ConclusionTreatment with dalteparin or dabigatran was associated with a decreased 90-day risk of VTE following primary TKA surgery compared with treatment with rivaroxaban.

KW - VENOUS THROMBOEMBOLISM

KW - THROMBOPROPHYLAXIS

KW - HIP

KW - ENOXAPARIN

KW - APIXABAN

KW - RIVAROXABAN

KW - ADVANCE-2

KW - SYSTEM

KW - DEATH

U2 - 10.1302/0301-620X.103B10.BJJ-2021-0023.R1

DO - 10.1302/0301-620X.103B10.BJJ-2021-0023.R1

M3 - Journal article

C2 - 34587805

VL - 103B

SP - 1571

EP - 1577

JO - Journal of Bone and Joint Surgery: British Volume

JF - Journal of Bone and Joint Surgery: British Volume

SN - 2049-4394

IS - 10

ER -