The prevention of venous thromboembolism and the risk of postoperative complications in patients with rheumatoid arthritis and osteoarthritis after total hip arthroplasty

Patients who have undergone large (hip, knee) joint replacement constitute a group at high risk for developing venous thromboembolic events (VTEs). According to different authors, the risk of nonpreventable VTEs in these patients varies from 40 to 80%.Objective: to analyze the incidence of VTE and the risk of postoperative wound-related bleeding and complications in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after total hip arthroplasty. Subjects and methods. The investigation enrolled 486 patients with RA (n=212) and OA (n=274) who underwent primary hip arthroplasty. Each patient group was divided into three subgroups according to prevention with the following drugs: 1) nadroparin calcium; 2) dabigatran etexilate; 3) nadroparin calcium switched to dabigatran etexilate. According to the International Society on Thrombosis and Haemostasis criteria, intra- and postoperative blood loss was assessed during the first 7 days after surgery; the wound healing process was also evaluated.Results and discussion. VTE was prevented with the drugs in 239 (49.2%) patients, 130 (26.8%) of them received nadroparin calcium, the remaining 117 (24.0%) patients had dabigatran etexilate or both drugs. Postoperative VTEs were recorded in 36 (7.4%) out of the 486 patients. VTEs were detected significantly less frequently In RA than in OA (1.2 and 6.1%, respectively; p=0.0013). VTEs were more commonly asymptomatic in both groups. No fatal bleeding was seen in any patient, which confirms the safety of anticoagulant therapy. Blood transfusions were more frequently given to bleeding patients with RA than to those with OA (14.4 and 5.7% of cases, respectively; p