Stopping antiplatelet therapy increases mortality risk after cardiac surgery for TKA patients
GENEVA — Discontinuation of antiplatelet therapy after major cardiac surgery increases the mortality rate of patients who undergo total knee arthroplasty, according to a speaker at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress 2012, here.
Researchers found that discontinuing clopidogrel and aspirin, an antiplatelet therapy (AT) used to prevent stent thrombosis in patients with coronary stents shortly before total knee arthroplasty (TKA) leads to an increased risk of mortality and coronary events.
“Overall, mortality risk was higher in patients with previous coronary stent placement that discontinued antiplatelet therapy prior to TKA up to 1 year,” Arvind G. von Keudell, MD, stated in his presentation. “Beyond 1 year, the mortality risk was the same in both treatment management groups.”
von Keudell and colleagues reported that patients who discontinued AT 1 year before TKA had an increased mortality risk of 12%, compared to 1.7% in patients who continued AT. Patients who discontinued AT at any point before TKA had an overall 23% risk of a cardiac event within 1 year, von Keudell said. He noted that risk of hematoma or bleeding did not affect overall mortality.
Limitations of the study include no differentiation between drug eluting and bare metal stents as well as no differentiation between the length, diameter, positioning and number of stents, von Keudell said.
von Keudell A, Thornhill T, Katz J, Losina E. Assessment of mortality risk in patients undergoing total knee arthroplasty after percutaneous coronary intervention. Paper #AW10-700. Presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress 2012. May 2-5. Geneva.
Disclosure: This study was funded by NIH research grants.