Effects of Preoperative Antiplatelet Agents and Anticoagulants on Total Joint Arthroplasty Outcomes

Background: Postoperative total joint arthroplasty complications place a tremendous burden on the health care system. The purpose of this study was to compare 30-day postoperative complication rates for surgeries in patients who received preoperative antiplatelet agents and/or anticoagulants to surgeries in a control group that did not receive antiplatelet agents and/or anticoagulants in the 90 days prior to undergoing a total joint arthroplasty. Methods: We retrospectively reviewed total hip or knee arthroplasties from November 2012 to March 2016. Surgeries were categorized into 4 groups depending on their preoperative antiplatelet and anticoagulant status. Complications between the groups were compared using chi-square analysis and Fisher exact test. Results: In this study, 1,726 arthroplasties in 1,544 patients were included. Superficial wound complications were the most common complication in all 4 groups (3.8% of surgeries), with no significant difference between the groups. A statistically significant difference was found in the number of prosthetic joint infections in the group of surgeries with no antiplatelets or anticoagulants compared to surgeries with both medications administered during the 90 days preoperatively (0.82% vs 5.13%, P=0.0003). No significant difference was found between the groups with regard to stroke, myocardial infarction, pulmonary embolism, or deep venous thrombosis. Conclusion: Surgeries for which both antiplatelets and anticoagulants were administered in the 90 days preoperatively had a statistically significantly higher rate of prosthetic joint infections compared to surgeries with neither medication administered preoperatively. Surgeons can use this information to better inform and risk-stratify patients prior to surgery.