Keywords
1. Thromboprophylaxis duration THA
2. Venous thromboembolism hip arthroplasty
3. Anticoagulant therapy osteoarthritis
4. Postoperative mortality THA
5. VTE prevention total hip replacement
Introduction
Total hip arthroplasty (THA) is a common and highly effective surgical intervention aimed at alleviating pain and improving function in patients suffering from hip osteoarthritis. However, the procedure is associated with a risk of venous thromboembolism (VTE), which is potentially preventable through the administration of anticoagulant thromboprophylaxis. The optimal duration of thromboprophylaxis following THA to balance the benefits and bleeding risk remains a topic of ongoing research and debate.
Optimal Duration of Thromboprophylaxis: Insights from the NARA Group Study
The Nordic Arthroplasty Register Association (NARA) group has contributed significantly to this area of inquiry. In 2019, the NARA group published findings from an extensive research project wherein they analyzed the outcomes of 55,540 primary THA patients with osteoarthritis in relation to the duration of anticoagulant thromboprophylaxis. This study assessed the risks of VTE, major bleeding, and death within the first 90 days post-surgery across three categories of thromboprophylaxis duration—short (1-5 days), standard (6-14 days), and extended (≥ 15 days).
Key Findings and Implications
The NARA group’s study found that the 90-day cumulative incidence of VTE was 1.0% for patients receiving standard treatment, 1.1% for short-term treatment, and 1.0% for extended treatment. The adjusted hazard ratios (aHRs) for major bleeding were not significantly different among the groups, with 1.1 for short treatment and 0.8 for extended treatment versus the standard treatment group. Importantly, patients who commenced on short-term thromboprophylaxis postoperatively experienced a higher 90-day mortality rate, whereas those who started on short-term treatment preoperatively did not face such increased risk.
Clinical Practice and Policy Development
Based on these findings, clinicians and policymakers should carefully consider the timing and duration of anticoagulant therapy for THA patients. The lack of overall clinically relevant differences in VTE and major bleeding risks across the different thromboprophylaxis durations points to the potential for flexible patient-centered approaches rather than a one-size-fits-all policy.
Discussion and Expert Opinions
Experts have called for further research to substantiate the NARA group’s observations on the increased 90-day mortality linked with postoperative short-term thromboprophylaxis. Also, there is increasing interest in exploring the individualized risk profiles of patients to tailor thromboprophylaxis regimes effectively.
Conclusion
The extensive patient data analyzed by the NARA group provides valuable insights into thromboprophylaxis duration post-THA. As research continues to evolve, these findings will play a critical role in shaping safe and effective anticoagulation practices for patients undergoing total hip arthroplasty.
References
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DOI: 10.1080/17453674.2019.1611215