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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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Detalles Bibliográficos
Autores principales: Kugelman, David, Teo, Greg, Doran, Michael, Buchalter, Daniel, Long, William J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141600/
https://www.ncbi.nlm.nih.gov/pubmed/34041330
http://dx.doi.org/10.1016/j.artd.2021.04.005
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author Kugelman, David
Teo, Greg
Doran, Michael
Buchalter, Daniel
Long, William J.
author_facet Kugelman, David
Teo, Greg
Doran, Michael
Buchalter, Daniel
Long, William J.
author_sort Kugelman, David
collection PubMed
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.
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spelling pubmed-81416002021-05-25 The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty Kugelman, David Teo, Greg Doran, Michael Buchalter, Daniel Long, William J. Arthroplast Today Original Research 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. Elsevier 2021-05-15 /pmc/articles/PMC8141600/ /pubmed/34041330 http://dx.doi.org/10.1016/j.artd.2021.04.005 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Kugelman, David
Teo, Greg
Doran, Michael
Buchalter, Daniel
Long, William J.
The Association Between Clopidogrel and Gastrointestinal Bleeding After Primary Total Joint Arthroplasty
title 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_short 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
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141600/
https://www.ncbi.nlm.nih.gov/pubmed/34041330
http://dx.doi.org/10.1016/j.artd.2021.04.005
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