ANTICOAGULATION FOLLOWING TOTAL JOINT ARTHROPLASTY: HEEDING THE RECOMMENDATIONS OF ACCP

Abstract

Introduction: The use of coumadin for prophylaxis against thromboembolism (TE) following total joint arthroplasty is the standard of care. In light of recent publication of the American College of Chest Physicians (ACCP), we altered our anticoagulation protocol to be compliant with the recommendations. This study evaluates the incidence of TE and bleeding complications following TJA when low dose coumadin vs. regular dose coumadin was administered.

Methods: 987 consecutive patients undergoing total joint arthroplasty by a single surgeon between the years of 2004–2005 were included. 446 patients operated on during the 2004 received low dose coumadin (intended INR 1.5–1.7) whilst 541 patients undergoing TJA during 2005 were given regular dose coumadin (intended INR 2–2.5).

Results: The mean INR for patients operated during the year 2005 was significantly higher than the INR for patients receiving TJA in 2004. There were more complications in 2005. There were 13 PE, 44 wound drainage, 4 DVT, and 11 hematoma formation (requiring surgical evacuation) during the year 2005 compared to 10 PE, 26 wound drainage, 6 DVT, and 5 hematoma formation in 2004. The difference for all complications except DVT was significant.

Conclusion: This study confirms the commonly held belief that aggressive anticoagulation does carry a higher incidence of complications such as wound drainage and bleeding. It appears that administering higher dose coumadin increased the bleeding complications without conferring additional protection against thromboembolic disease.