Skip to main content
ISTH 2024 Main banner
Back

Poster Networking

Venous Thromboembolism

PB0408 - Thrombotic and hemorrhagic complications in patients undergoing major orthopedic surgery

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall
Background: Peri-operative management of oral anticoagulants (OAC) in the context of orthopedic surgery for major orthopedic surgery in elderly patients, is challenging, because of the presence of multiple co-morbidities and medical treatments

Aims: To collect data on the peri-operative management of anticoagulation/antiplatelets therapy in elderly patients who need emergency or elective orthopedic surgery;

Methods: ORTHO-START is a multicentre, prospective, study investigating management of consecutive patients taking or not OAC and / or antiplatelet agents requiring elective intervention of hip /knee replacement or urgent surgery for hip fracture.

Results: 1077 patients (July 2018- July 2022), with mean age 79.3 +11.2) were recruited (775, 72.3% women): 329 (30.5%) patients were taking antiplatelets, 167 (15.5%) Direct Oral Anticoagulants (DOAC), 81 (7.5%) Vitamin K antagonists (VKA) and 3 (0.3%) heparins or fondaparinux. Overall, 16 had previous deep vein thrombosis, 15 pulmonary embolism ( Table). At 24 months follow-up, 210 (19.6%) fatalities were recorded, with mortality rate not higher in those taking vs "not taking" OAC/antiplatelets (18.7% vs 20.5%). Overall complications in the peri-operative period were significantly higher in patients taking OAC or antiplatelets (33 vs 11 in those not taking OAC/antiplatelets, p< 0.001) (Table). Nine hemorrhagic complications were observed in the peri-operative period: 5 in patients taking OAC, 4 in those not taking OAC/ antiplatelets (p < 0.001); 8 thrombotic complications were observed in patients taking OAC, 5 in those not taking OAC/antiplatelets and 0 in those on antiplatelets (p < 0.001). No difference was observed as for thrombotic or hemorrhagic complications by type (i.e.: elective/urgent) of surgery. Transfusion rate was not dependent on OAC/ antiplatelets therapy ( 37%, 36.8% and 34.1% in those taking OAC, antiplatelets or neither, respectively).

Conclusion(s): Post-operative thrombotic and hemorrhagic complications are higher in patients taking OAC than in those taking antiplatelets or neither. There is not difference between these groups in mortality at 24 months.