Hip Replacement Surgery and Anticoagulation; A Mortality, Transfusion Need and Venous Thromboembolism Rate Analysis with Trinetx

Introduction: Hip replacement surgery is usually performed in elderly patients and may lead to complications such as major bleeding and venous thromboembolism (VTE). Also, there is a higher proportion of anticoagulated patients within the elderly. Classically, vitamin K antagonists (VKA) have been associated with higher risk of bleeding and with other perioperative and post-operative complications. The aim of this study is to analyse and compare the mortality, the blood transfusion needs and the VTE rate in patients anticoagulated with VKA and in patients treated with direct oral anticoagulants (DOACs) who went through hip replacement surgery.

Methods: TriNetX is the global federated health research network providing access to electronic medical records across large healthcare organizations (HCO), with a database of more than 80 million patients. This report was run on the set of HCOs grouped into a network called Global - Anonymous. This network included 113 HCOs.

This analysis compared the outcomes of two cohorts; Cohort A: hip replacement + DOACs, and Cohort B: hip replacement + VKA, in the last 2 years. Propensity score matching was performed in both cohorts, so the main difference between them was the type of anticoagulant therapy. Demographic and comorbidities data, 90-days mortality, blood transfusion need and thrombotic events until 90 days after discharge were analysed.

Results: A total of 8,270 patients were included in cohort A and 11,750 in cohort B. After propensity score matching was performed, both cohorts included 7,940 patients. The main characteristics are shown in table 1, no significant differences were found.

There were more deaths in the cohort B than in the cohort A, specifically in cohort B there were 950 deaths while in cohort B there were 780 (HR 1.11, CI95% 1.008, 1.221, p= 0.001).

The patients who received DOACs as anticoagulant treatment showed a significantly lower need of blood transfusion than patients treated with VKA; 970 patients needed transfusion in cohort A while 1,210 had need of transfusion in cohort B (OR: 0.77 95%CI: 0.7-0.84).

Regarding VTE, there were no significant differences between both cohorts. 1,640 patients suffered thromboembolic events in cohort A while in cohort B there were 1,580 (OR: 1.05 95%CI: 0.97-1.13).

Conclusions: According to the results of this study, in the context of hip replacement surgery, anticoagulation with DOACs is associated with a lower 90-days mortality and with a lower need of blood transfusion, with no difference in the VTE rate in the post-operative.

So, it is of great importance to individualize the thrombotic risk and the haemorrhagic risk before the hip replacement surgery in order to do a correct management of the anticoagulation, including the bridging therapy especially in those patients anticoagulated with VKA, in order to prevent perioperative complications.

DOACs are a safer option than VKA as an anticoagulant treatment, especially in the elderly, who might need more surgical treatments. The use of DOACs as anticoagulant treatment should be extended as their security profile is safer than VKA, since they associate a lower mortality and can prevent blood transfusions.

No relevant conflicts of interest to declare.