Risk assessment and analysis of related factors for venous thromboembolism and bleeding after hip and knee replacement in elderly patients

Qin Gang; Long Yuntao; Liang Weiming

doi:10.3760/j.issn.1673-4777.2024.12.014

Abstract：Objective To evaluate the efficacy of aspirin and new oral anticoagulants(NOACs)in the prevention of venous thromboembolism(VTE)and bleeding events after hip and knee arthroplasty in the elderly,and to analyze the related risk factors.Methods This study was a retrospective cohort study.A total of 1 032 elderly patients who underwent hip and knee arthroplasty in the First Affiliated Hospital of Guangxi University of Science and Technology from January 2018 to December 2022 were consecutively enrolled.According to the anticoagulant therapy regimen,the patients were divided into aspirin group(674 cases)and NOACs group(358 cases).The baseline data were matched 1∶1 by propensity score matching(PSM)method.Finally,a total of 652 patients were enrolled and divided into aspirin group(326 cases)and NOACs group(326 cases).The main outcome measures were VTE events and bleeding events within 90 d after surgery.Cox proportional hazards regression model was used to analyze the risk factors.Results There were no significant differences in baseline data and incidence of VTE events between the two groups before and after PSM matching(all P＞0.05).Before and after PSM matching,the incidence of bleeding events in the NOACs group was lower than that in the aspirin group[6.1％(22/358)vs 8.0％(54/674),4.9％(16/326)vs 8.3％(27/326)](all P＜0.05).Cox regression model analysis showed that male,knee replacement,chronic kidney disease,previous history of VTE,and anticar-diolipin antibodies or lupus anticoagulant were significant risk factors for VTE events(all P＜0.05).Age,cancer,chronic kidney disease,and length of hospital stay were all significant risk factors for bleeding events(all P＜0.05).Conclusions Aspirin and NOACs have similar efficacy in preventing VTE after hip and knee arthro-plasty in the elderly,and aspirin therapy has a higher risk of bleeding.Male sex,knee replacement,chronic kidney disease,previous history of VTE,and anticardiolipin antibodies or lupus anticoagulant are the main risk factors for VTE,while age,cancer,chronic kidney disease,and length of hospital stay are the main risk factors for bleeding events.