Multiple Venous Thromboembolism Pharmacologic Agents Are Associated with an Increased Risk for Early Postoperative Complications following a Total Joint Arthroplasty

Abstract

The purpose of this study was to determine the effect that concurrent venous thromboembolism (VTE) medications had on early outcomes following primary total joint arthroplasty (TJA). 2653 total knee and hip arthroplasties were reviewed at a tertiary medical center. The study performed a multivariable comparison of outcomes in patients on 2 or more VTE medications, as well as a logistic regression on outcomes following each addition of a VTE medication postoperatively (number of VTE medications was 1–4). Controlling for gender, age, body mass index, and preoperative American Society of Anesthesiologists score throughout the analysis, patients who received 2 or more VTE prophylaxis medications had increased LOS ( $p<0.001$ ), transfusions ( $p<0.001$ ), emergency department visits ( $p=0.001$ ), readmissions ( $p<0.001$ ), 90dPOE ( $p<0.001$ ), and PE ( $p<0.001$ ). Every additional postoperative VTE medication incrementally increased the risk for longer LOS ( $p<0.001$ ), transfusions ( $p<0.001$ ), 90dPOE ( $p<0.001$ ), deep vein thrombosis ( $p=0.049$ ), PE ( $p<0.001$ ), emergency department visits ( $p=0.005$ ), and readmission ( $p=0.010$ ). Patients on multiple VTE medications following TJA demonstrate significantly poorer outcomes. The current study’s findings caution the use of multiple VTE medications whenever possible immediately following a TJA.