Increased Anticoagulant Requirement in Total Hip Replacement Patients Post-COVID: A Comparative Study in the Indian Population.

Introduction: India's healthcare landscape features a blend of modern medicine and alternative systems, which gained widespread use during the COVID-19 pandemic. The undocumented use of traditional remedies and unregulated substances limited formal diagnosis and treatment records, complicating post-operative risk assessment. The pandemic has had lasting effects on vascular and coagulation systems. This study aims to evaluate and compare low molecular weight heparin (LMWH) requirements in patients undergoing total hip replacement (THR) in the pre-and post-COVID eras. Materials and Methods: A retrospective cohort study was conducted, including 150 patients who underwent elective THR. The patients were divided into pre-COVID (2018-2019; n = 75) and post-COVID (2022-2024; n = 75) cohorts with no prior anticoagulant usage and no deep vein thrombosis (DVT) nor pulmonary embolism (PE) before the surgery. Post-COVID group includes patients who deny COVID infection. Data collected included demographics, comorbidities, LMWH dose and duration, laboratory values (D-dimer, prothrombin time [PT], activated partial thromboplastin time, platelet count), and post-operative outcomes such as DVT, PE, and bleeding complications. Statistical analysis included t-tests, Chi-square tests, and logistic regression. Results: The post-COVID group showed significantly increased LMWH requirements: 77.3% received 60 mg (0.6 mL) versus. 42.7% in the pre-COVID group (P < 0.00001). The incidence of DVT was also higher post-COVID (17.3% vs. 4.0%, P = 0.01), while bleeding complications were not significantly different (P > 0.05). Elevated D-dimer and PT values persisted in the post-COVID cohort. Logistic regression identified post-COVID cohort as an independent risk factor for increased anticoagulation needs (odds ratio = 2.34, P = 0.02). Discussion: Post-COVID patients demonstrate a prothrombotic state, likely due to persistent endothelial injury. The use of LMWH in adjusted doses was effective and did not increase bleeding risk, underscoring the need for tailored anticoagulation protocols. Conclusion: THR patients in the post-COVID era exhibit a heightened thrombotic profile, possibly due to persistent endothelial dysfunction and coagulopathy induced by prior SARS-CoV-2 infection, necessitating increased anticoagulant dosages and duration, without a concomitant rise in bleeding events. These results support individualized anticoagulation protocols and post-operative monitoring, particularly in post-COVID patients, to optimize outcomes in high-risk orthopedic populations.