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Poster Networking

Venous Thromboembolism

PB0385 - Sex differences in patients taking oral anticoagulants or anti-platelets who undergo major orthopedic surgery

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall
Background: Sex differences in clinical studies are a challenging issue in the definition of impact on outcomes, including mortality. Stratification of patients by sex/gender is imperative to improve outcomes, quality of life, and economic sustainability. Major orthopedic surgery are more frequent in women than in men with scarce data on clinical differences in terms of risk factors and outcomes stratified by sex.

Aims: To investigate differences between women and men in mortality rate, venous thromboembolism, arterial events, transfusion rate.

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: Six Italian Centres recruited 1077 patients (July 2018- March 2022). Of 1077 patients, 775 (72.3%) were women. At admission, women were significantly older than men and showed hemoglobin (Hb) values significantly lower ( p< 0.001), whereas their BMI was significantly higher (Table). No difference was observed in the prevalence of co-morbidities, smokers more represented among men ( 13.0% vs 4.6%, p< 0.001). A significantly higher percentage of women showed previous pulmonary embolism (1.9% vs 0.4%, p: 0.07). Femur fracture and hip arthroplasty were significantly more represented in women, with no difference in the prescription of oral anticoagulants (OAC) or antiplatelets (Table). Mortality rate at 24 months was significantly higher in men (31.4% vs 18%, p.=0.018). Post-operative thrombotic and hemorrhagic complications were more frequent in women, although these differences did not reach statistical significance (Table). Lastly, we observed that women were significantly more transfused (37.9% vs 30%, p: 0.012). No difference in transfusion rate was observed in those taking OAC or antiplatelets after adjusting for sex.

Conclusion(s): Present data give implications for practice, as underscore how relevant is a raised awareness of sex/gender issues when we assess and care for patients.