The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty
Background: Anticoagulation after total joint arthroplasty has been demonstrated to reduce venous thromboembolism. However, anticoagulation can lead to adverse bleeding events. The purpose of this study was to assess if an association exists between specific anticoagulation modalities, such as clopi...
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doaj-be8b2f704bc34731987fb24cee32b50e2021-07-01T04:34:20ZengElsevierArthroplasty Today2352-34412021-06-0196164The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint ArthroplastyDavid Kugelman, MD0Greg Teo, MD1Michael Doran, MD2Daniel Buchalter, MD3William J. Long, MD, FRCSC4Investigation Conducted at New York University Langone Orthopaedic Hospital, New York, NY, USAInvestigation Conducted at New York University Langone Orthopaedic Hospital, New York, NY, USAInvestigation Conducted at New York University Langone Orthopaedic Hospital, New York, NY, USAInvestigation Conducted at New York University Langone Orthopaedic Hospital, New York, NY, USACorresponding author. Department of Orthopaedics, New York University Langone Orthopaedic Hospital, 14th floor, 301 East 17 St, Manhattan New York 10003, USA.; Investigation Conducted at New York University Langone Orthopaedic Hospital, New York, NY, USABackground: Anticoagulation after total joint arthroplasty has been demonstrated to reduce venous thromboembolism. However, anticoagulation can lead to adverse bleeding events. The purpose of this study was to assess if an association exists between specific anticoagulation modalities, such as clopidogrel, and postoperative gastrointestinal (GI) bleeding. Methods: A prospective cohort of Medicare patients undergoing total joint arthroplasty from 2017 to 2019 (3535 patients) was retrospectively reviewed. The baseline characteristics and anticoagulation methods were compared between the “GI bleed” cohort and the “non-GI bleed cohort.” Independent t-tests were conducted for continuous variables, while chi-squared analysis was conducted for dichotomous variables. Results: Thirteen patients (0.42%) sustained a postoperative complication of a GI bleed. The mean age for patients sustaining a GI bleed was 69.23 years compared with 72.30 years for the non-GI bleed cohort (P = .11). Six patients who sustained a GI bleed (46%) were on an anticoagulation therapy other than aspirin, and this trended toward significance (P = .09). Five patients who sustained a GI bleed (38%) were on clopidogrel (P < .01). Seven percent of patients on clopidogrel sustained a postoperative GI bleed (P < .01). None of the patients who sustained a postoperative GI bleed had a history of peptic ulcer disease. Conclusion: Patients on clopidogrel in the acute perioperative period demonstrated a strong association with the complication of postoperative GI bleeding. Arthroplasty surgeons should be aware of this association to educate and monitor patients on clopidogrel therapy and to work as part of interdisciplinary teams to assess the risks vs benefits of perioperative clopidogrel.http://www.sciencedirect.com/science/article/pii/S2352344121000595Total joint arthroplastyTotal knee arthroplastyTotal hip arthroplastyComplications following arthroplastyGastrointestinal bleeding |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David Kugelman, MD Greg Teo, MD Michael Doran, MD Daniel Buchalter, MD William J. Long, MD, FRCSC |
spellingShingle |
David Kugelman, MD Greg Teo, MD Michael Doran, MD Daniel Buchalter, MD William J. Long, MD, FRCSC The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty Arthroplasty Today Total joint arthroplasty Total knee arthroplasty Total hip arthroplasty Complications following arthroplasty Gastrointestinal bleeding |
author_facet |
David Kugelman, MD Greg Teo, MD Michael Doran, MD Daniel Buchalter, MD William J. Long, MD, FRCSC |
author_sort |
David Kugelman, MD |
title |
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty |
title_short |
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty |
title_full |
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty |
title_fullStr |
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty |
title_full_unstemmed |
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty |
title_sort |
association between clopidogrel and gastrointestinal bleeding after primary total joint arthroplasty |
publisher |
Elsevier |
series |
Arthroplasty Today |
issn |
2352-3441 |
publishDate |
2021-06-01 |
description |
Background: Anticoagulation after total joint arthroplasty has been demonstrated to reduce venous thromboembolism. However, anticoagulation can lead to adverse bleeding events. The purpose of this study was to assess if an association exists between specific anticoagulation modalities, such as clopidogrel, and postoperative gastrointestinal (GI) bleeding. Methods: A prospective cohort of Medicare patients undergoing total joint arthroplasty from 2017 to 2019 (3535 patients) was retrospectively reviewed. The baseline characteristics and anticoagulation methods were compared between the “GI bleed” cohort and the “non-GI bleed cohort.” Independent t-tests were conducted for continuous variables, while chi-squared analysis was conducted for dichotomous variables. Results: Thirteen patients (0.42%) sustained a postoperative complication of a GI bleed. The mean age for patients sustaining a GI bleed was 69.23 years compared with 72.30 years for the non-GI bleed cohort (P = .11). Six patients who sustained a GI bleed (46%) were on an anticoagulation therapy other than aspirin, and this trended toward significance (P = .09). Five patients who sustained a GI bleed (38%) were on clopidogrel (P < .01). Seven percent of patients on clopidogrel sustained a postoperative GI bleed (P < .01). None of the patients who sustained a postoperative GI bleed had a history of peptic ulcer disease. Conclusion: Patients on clopidogrel in the acute perioperative period demonstrated a strong association with the complication of postoperative GI bleeding. Arthroplasty surgeons should be aware of this association to educate and monitor patients on clopidogrel therapy and to work as part of interdisciplinary teams to assess the risks vs benefits of perioperative clopidogrel. |
topic |
Total joint arthroplasty Total knee arthroplasty Total hip arthroplasty Complications following arthroplasty Gastrointestinal bleeding |
url |
http://www.sciencedirect.com/science/article/pii/S2352344121000595 |
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