PB1368 - Risk of bleeding and venous thromboembolism in patients using therapeutic dosage of Direct Oral Anticoagulants undergoing total hip or total knee arthroplasty

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Mark J.R. Smeets, MD

PhD student
Department of Clinical Epidemiology, Leiden University Medical Center, The Netherlands
The Hague, Zuid-Holland, Netherlands

Co-Author(s)

EK

Eskild Bendix Kristiansen

Statistician
Department of Clinical Epidemiology and Department of Clinical Medicine, Aarhus University
Aarhus, Midtjylland, Denmark
Banne Nemeth, MD, PhD

Postdoc
Department of Clinical Epidemiology and Department of Orthopedics, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
SC

Suzanne C. Cannegieter, MD PhD

Professor
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
AP

Alma Becic Pedersen

Professor
Department of Clinical Epidemiology and Department of Clinical Medicine, Aarhus University
Aarhus, Midtjylland, Denmark

Background: About 1.0%-1.5% of patients undergoing total hip (THA) or total knee arthroplasty (TKA) still develop postoperative VTE, indicating that current clinical practice of thromboprophylaxis is not sufficient in high-risk individuals. Results from dose-ranging studies with direct oral anticoagulants (DOACs) suggest a higher efficacy of therapeutic dosages of DOACs for VTE prevention, albeit at an increased bleeding risk.

Aims: To estimate the feasibility of providing DOACs in therapeutic dose as thromboprophylaxis for high-risk VTE patients, we aimed to determine risks of bleeding and VTE in patients who underwent THA or TKA and who are also treated with long-term DOAC in therapeutic dose, e.g., for atrial fibrillation (AF).

Methods: We conducted a registry-based cohort study on Danish data from 2000 through 2018. The primary cohort of interest consisted of AF patients on therapeutic dosages of DOACs who underwent THA or TKA. Two control cohorts were formed: 1) patients undergoing THA/TKA using a prophylactic dose and 2) AF patients on therapeutic dose of DOACs not undergoing THA/TKA. 6- and 12-week cumulative incidences of bleeding and VTE with death as competing risk were assessed.

Results: A total of 1,595 patients were included in the therapeutic dose THA/TKA cohort (table 1). Of these patients 15 developed bleeding and 14 developed VTE. The 6- and 12-week cumulative incidences for bleeding were 0.3% (95%CI 0.1 to 0.7) and 0.9% (95%CI 0.6 to 1.5), respectively (table 2). For VTE these numbers were 0.8% (95%CI 0.4 to 1.3) and 0.9% (95%CI 0.5 to 1.4). Bleeding complications were lower in both control cohorts while VTE incidence was slightly higher in the THA/TKA control cohort on regular thromboprophylaxis.

Conclusion(s): These results suggest that a therapeutic dosage of DOACs might be a feasible option to prevent VTE after THA/TKA in patients at high risk of VTE which can form a basis for further studies.