Evidence map›Paper›PMID 35417028›Full record

ArticleActa orthopaedica2022

Association of perioperative thromboprophylaxis on revision rate due to infection and aseptic loosening in primary total hip arthroplasty - new evidence from the Nordic Arthroplasty Registry Association (NARA).

Thea Emily Benson, Ina Trolle Andersen, Søren Overgaard, Anne Marie Fenstad, Stein Atle Lie, Jan-Erik Gjertsen, Ove Nord Furnes, Alma Becic Pedersen

Abstract read
In one paragraph

Article in Acta orthopaedica, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Thea Emily BensonDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. thea.emily92@gmail.com.
Ina Trolle AndersenDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. ita@clin.au.dk.
Søren OvergaardCopenhagen University Hospital, Bispebjerg, Department of Orthopaedic Surgery and Traumatology, and University of Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark. soeren.overgaard@regionh.dk.
Anne Marie FenstadThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway. anne.marie.fenstad@helse-bergen.no.
Stein Atle LieThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Dentistry, University of Bergen, Bergen, Norway. stein.lie@uib.no.
Jan-Erik GjertsenThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. jan-erik.gjertsen@helse-bergen.no.
Ove Nord FurnesThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. ove.nord.furnes@helse-bergen.no.
Alma Becic PedersenDepartment of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. abp@clin.au.dk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeResults regarding the impact of anticoagulants on revision rate are conflicting. We examined the association between the use of low molecular weight heparin (LMWH) or non-vitamin K oral anticoagulants (NOACs) as thromboprophylaxis after primary total hip arthroplasty (THA) and the revision rate due to infection, aseptic loosening, and all causes. PATIENTS AND

methodsWe conducted a cohort study (n = 53,605) based on prospectively collected data from the national hip arthroplasty registries from Denmark and Norway. The outcome was time to revision due to infection, aseptic loosening, and all causes, studied separately. Kaplan-Meier (KM) survival analysis and a Cox proportional hazard model was used to estimate implant survival and cause-specific hazard ratios (HRs) with 95% confidence intervals (CI) adjusting for age, sex, Charlson Comorbidity Index, fixation type, start, and duration of thromboprophylaxis, and preoperative use of Vitamin K antagonists, NOAC, aspirin, and platelet inhibitors as confounders.

resultsWe included 40,451 patients in the LMWH group and 13,154 patients in the NOAC group. Regarding revision due to infection, the 1-year and 5-year KM survival was 99% in both the LMWH group and in the NOAC group. During the entire follow-up period, the adjusted HR for revision due to infection was 0.9 (CI 0.7-1.1), 1.6 (CI 1.3-2.1) for aseptic loosening, and 1.2 (CI 1.1-1.4) for all-cause revision for the NOAC compared with the LMWH group. The absolute differences in revision rates between the groups varied from 0.2% to 1%.

interpretationCompared with LMWH, NOACs were associated with a slightly lower revision rate due to infection, but higher revisions rates due to aseptic loosening and all-cause revision. The absolute differences between groups are small and most likely not clinically relevant. In addition, the observed associations might partly be explained by selection bias and unmeasured confounding, and should be a topic for further research.

Indexed as

Arthroplasty, Replacement, HipHip ProsthesisVenous ThromboembolismAdministration, OralAnticoagulantsCohort StudiesHeparin, Low-Molecular-WeightHumansProsthesis DesignProsthesis FailureRegistriesReoperationRisk FactorsAnticoagulantsHeparin, Low-Molecular-Weight

Identifiers

PMID35417028
PMCPMC9006590

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.