The Journal of Arthroplasty, Volume 29, Issue 2, 320 - 324

Complications of Perioperative Warfarin Therapy in Total Knee Arthroplasty

Simpson, Phil M.S. et al.

Patients presenting for knee replacement on warfarin for medical reasons often require higher levels of anticoagulation peri-operatively than primary thromboprophylaxis and may require bridging therapy with heparin. We performed a retrospective case control study on 149 consecutive primary knee arthroplasty patients to investigate whether anti-coagulation affected short-term outcomes. Specific outcome measures indicated significant increases in prolonged wound drainage (26.8% of cases vs 7.3% of controls, P<0.001); superficial infection (16.8% vs 3.3%, P<0.001); deep infection (6.0% vs 0%, P<0.001); return-to-theatre for washout (4.7% vs 0.7%, P=0.004); and revision (4.7% vs 0.3%, P=0.001). Management of patients on long-term warfarin therapy following TKR is particularly challenging, as the surgeon must balance risk of thromboembolism against post-operative complications on an individual patient basis in order to optimise outcomes.

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