Mortality Risk Assessment of Total Knee Arthroplasty and Related Surgery After Percutaneous Coronary Intervention

Overview

Journal Open Orthop J

Publisher Bentham Open

Specialty Orthopedics

Date 2017 Feb 2

PMID 28144380

Citations 1

Authors

Arvind G von Keudell

Thomas S Thornhill

Jeffrey N Katz

Elena Losina

Affiliations

Soon will be listed here.

Abstract

Background: The optimal antiplatelet therapy (APT) treatment strategy after Coronary Artery Stenting (CAS) in non-cardiac surgery, such as total knee arthroplasty (TKA) or urgent TKA-related surgery remains unknown.

Methods: We built a decision tree model to examine the mortality outcomes of two alternative strategies for APT after CAS use in the perioperative period namely, continuous use and discontinuation.

Results: If surgery was performed in the first month after CAS placement, discontinuing APT led to an estimated 30-day post TKA mortality of 10.5%, compared to 1.0% in a strategy with continuous APT use. Mortality with both strategies decreased with longer intervals.

Conclusion: Our model demonstrated that APT discontinuation in patients undergoing TKA or urgent TKA related surgery after CAS placement might lead to greater 30-day mortality up to one year.

Citing Articles

Periprosthetic Joint Infection After Bariatric Surgical Anastomotic Leak.

DesLaurier J, Chung J, Hussain A, Patetta M, Gonzalez M, Meller M J Am Acad Orthop Surg Glob Res Rev. 2020; 4(1).

PMID: 32159065 PMC: 7028785. DOI: 10.5435/JAAOSGlobal-D-19-00095.

References

Serruys P, Kutryk M, Ong A . Coronary-artery stents. N Engl J Med. 2006; 354(5):483-95. DOI: 10.1056/NEJMra051091. View

Conroy M, Bolsin S, Black S, Orford N . Perioperative complications in patients with drug-eluting stents: a three-year audit at Geelong Hospital. Anaesth Intensive Care. 2007; 35(6):939-44. DOI: 10.1177/0310057X0703500613. View

Parvizi J, Sullivan T, Trousdale R, Lewallen D . Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am. 2001; 83(8):1157-61. DOI: 10.2106/00004623-200108000-00004. View

Movahed M, Ramaraj R, Jamal M, Hashemzadeh M . Nationwide trends in the utilisation of percutaneous coronary intervention (PCI) in the United States of America based on gender and ethnicities. EuroIntervention. 2009; 5(3):343-8. DOI: 10.4244/v5i3a54. View

Reddy P, Vaitkus P . Risks of noncardiac surgery after coronary stenting. Am J Cardiol. 2005; 95(6):755-7. DOI: 10.1016/j.amjcard.2004.11.029. View

Cruden N, Harding S, Flapan A, Graham C, Wild S, Slack R . Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery. Circ Cardiovasc Interv. 2010; 3(3):236-42. DOI: 10.1161/CIRCINTERVENTIONS.109.934703. View

Cutlip D, Baim D, Ho K, Popma J, Lansky A, Cohen D . Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation. 2001; 103(15):1967-71. DOI: 10.1161/01.cir.103.15.1967. View

Galat D, McGovern S, Hanssen A, Larson D, Harrington J, Clarke H . Early return to surgery for evacuation of a postoperative hematoma after primary total knee arthroplasty. J Bone Joint Surg Am. 2008; 90(11):2331-6. DOI: 10.2106/JBJS.G.01370. View

Anwaruddin S, Askari A, Saudye H, Batizy L, Houghtaling P, Alamoudi M . Characterization of post-operative risk associated with prior drug-eluting stent use. JACC Cardiovasc Interv. 2009; 2(6):542-9. DOI: 10.1016/j.jcin.2009.03.014. View

10.

Pauker S, Kassirer J . The threshold approach to clinical decision making. N Engl J Med. 1980; 302(20):1109-17. DOI: 10.1056/NEJM198005153022003. View

11.

Lavelle W, Demers Lavelle E, Uhl R . Operative delay for orthopedic patients on clopidogrel (plavix): a complete lack of consensus. J Trauma. 2008; 64(4):996-1000. DOI: 10.1097/TA.0b013e3180485d23. View

12.

Gandhi N, Abdel-Karim A, Banerjee S, Brilakis E . Frequency and risk of noncardiac surgery after drug-eluting stent implantation. Catheter Cardiovasc Interv. 2010; 77(7):972-6. DOI: 10.1002/ccd.22744. View

13.

Nandi S, Aghazadeh M, Talmo C, Robbins C, Bono J . Perioperative clopidogrel and postoperative events after hip and knee arthroplasties. Clin Orthop Relat Res. 2012; 470(5):1436-41. PMC: 3314755. DOI: 10.1007/s11999-012-2306-7. View

14.

Brotman D, Bakhru M, Saber W, Aneja A, Bhatt D, Tillan-Martinez K . Discontinuation of antiplatelet therapy prior to low-risk noncardiac surgery in patients with drug-eluting stents: a retrospective cohort study. J Hosp Med. 2007; 2(6):378-84. DOI: 10.1002/jhm.227. View

15.

Berger P, Kleiman N, Pencina M, Hsieh W, Steinhubl S, Jeremias A . Frequency of major noncardiac surgery and subsequent adverse events in the year after drug-eluting stent placement results from the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry. JACC Cardiovasc Interv. 2010; 3(9):920-7. DOI: 10.1016/j.jcin.2010.03.021. View

16.

Jacob A, Hurley S, Loughran S, Wetsch T, Trousdale R . Continuing clopidogrel during elective total hip and knee arthroplasty: assessment of bleeding risk and adverse outcomes. J Arthroplasty. 2013; 29(2):325-8. DOI: 10.1016/j.arth.2013.06.008. View

17.

Kaluza G, Joseph J, Lee J, Raizner M, Raizner A . Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol. 2000; 35(5):1288-94. DOI: 10.1016/s0735-1097(00)00521-0. View

18.

Assali A, Vaknin-Assa H, Lev E, Bental T, Ben-Dor I, Teplitsky I . The risk of cardiac complications following noncardiac surgery in patients with drug eluting stents implanted at least six months before surgery. Catheter Cardiovasc Interv. 2009; 74(6):837-43. DOI: 10.1002/ccd.22158. View

19.

Fleisher L, Beckman J, Brown K, Calkins H, Chaikof E, Fleischmann K . 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2009; 54(22):e13-e118. DOI: 10.1016/j.jacc.2009.07.010. View

20.

Gunay R, Sensoz Y, Kayacioglu I, Demirtas M . eComment: Controversies on the antiplatelet therapy before coronary artery bypass grafting surgery. Interact Cardiovasc Thorac Surg. 2009; 10(1):52. DOI: 10.1510/icvts.2009.211805A. View