Abstract
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with high rates of venous thromboembolism (VTE). Anticoagulants, such as warfarin, are commonly used to prevent VTE in such patients. The practice and effectiveness of warfarin in real world populations is not well documented. 595 TKA and THA patients treated with warfarin were followed by two anticoagulation clinics in the Michigan Anticoagulation Quality Improvement Initiative. Length of prescribed anticoagulation, percent time in therapeutic range (%TTR) and time to first therapeutic INR were calculated for each surgical group. For THA, all 300 patients received at least ten days with a 28-day median length of anticoagulation therapy. For TKA, all 295 patients received at least 10 days with a 28-day median length of anticoagulation therapy. For THA patients, time to first therapeutic INR was on average 12.0 ± 8.0 days with a mean %TTR of 36.6 ± 26.8 % for goal INR 2.0–3.0. For THA patients, 39 (13 %) never reached target INR. For TKA patients, time to first therapeutic INR was on average 12.8 ± 10.3 days with a mean %TTR of 36.0 ± 28.3 % for goal INR 2.0–3.0. For TKA patients, 44 (14.9 %) never reached target INR. Many orthopaedic surgeons who use warfarin for post-arthroplasty VTE prophylaxis do so in accordance with national guidelines. The time to first therapeutic INR is strikingly long and %TTR markedly low for these patients, raising questions about the efficacy of warfarin therapy in the first 1–2 post-operative weeks. Further studies to investigate the best target INR for warfarin prophylaxis, as well as the composite rates of VTE and clinically relevant bleeding from treatment with warfarin, LMWH and newer anticoagulants are needed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edn). Chest 133:381S–453S
Eikelboom JW, Quinlan DJ, Douketis JD (2001) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet 358:9–15
Cohen AT, Bailey CS, Alikhan R, Cooper DJ (2001) Extended thromboprophylaxis with low molecular weight heparin reduces symptomatic venous thromboembolism following lower limb arthroplasty a meta-analysis. Thromb Haemost 85:940–941
Prandoni P, Bruchi O, Sabbion P, Tanduo C, Scudeller A, Sardella C et al (2002) Prolonged thromboprophylaxis with oral anticoagulants after total hip arthroplasty: a prospective controlled randomized study. Arch Intern Med 162:1966–1971
Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pellegrini V et al (2009) American academy of orthopaedic surgeons clinical practice guideline on. prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Bone Joint Surg Am 91:1756–17577
Rosemont, IL (ed) (2011) Preventing venous thromboembolis disease in patients undergoing elective hip and knee arthroplasty: evidence-based guideline and evidence report 2nd edn American Academy of Orthopaedic Surgeons
Markel DC, York S, Liston MJ Jr, Flynn JC, Barnes CL, Davis CM III (2010) Venous thromboembolism: management by American association of hip and knee surgeons. J Arthroplasty 25(3–9):e1–2
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al (2012) Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e278S–325S
Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E (1993) A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 69:236–239
Schulman S, Kearon C (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694
Mismetti P, Laporte S, Zufferey P, Epinat M, Decousus H, Cucherat M (2004) Prevention of venous thromboembolism in orthopedic surgery with vitamin K antagonists: a meta-analysis. J Thromb Haemost 2:1058–1070
Dahl OE, Quinlan DJ, Bergqvist D, Eikelboom JW (2010) A critical appraisal of bleeding events reported in venous thromboembolism prevention trials of patients undergoing hip and knee arthroplasty. J Thromb Haemost 8:1966–1975
Turpie AG, Bauer KA, Eriksson BI, Lassen MR (2002) Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med 162:1833–1840
Becattini C, Lignani A, Agnelli G (2010) New anticoagulants for the prevention of venous thromboembolism. Drug Des Dev Ther 4:49–60
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barnes, G.D., Kaatz, S., Golgotiu, V. et al. Use of warfarin for venous thromboembolism prophylaxis following knee and hip arthroplasty: results of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2). J Thromb Thrombolysis 35, 10–14 (2013). https://doi.org/10.1007/s11239-012-0766-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11239-012-0766-y