Article

Does “Excessive” Anticoagulation Predispose to Periprosthetic Infection?

Rothman Institute of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
The Journal of Arthroplasty (Impact Factor: 2.67). 10/2007; 22(6 Suppl 2):24-8. DOI: 10.1016/j.arth.2007.03.007
Source: PubMed

ABSTRACT

Although persistent drainage and hematoma formation are recognized risk factors for the development of periprosthetic infection, it is not known if excess anticoagulation is a predisposing factor. We conducted a 2 to 1 case-control study with 78 cases who underwent revision for septic failure. The controls underwent the same index procedure but did not develop consequent infection. Patient comorbidities, medications, intraoperative, and postoperative factors were compared. Postoperative wound complications including development of hematoma and wound drainage were significant risk factors for periprosthetic infection. A mean international normalized ratio of greater than 1.5 was found to be more prevalent in patients who developed postoperative wound complications and subsequent periprosthetic infection. Cautious anticoagulation to prevent hematoma formation and/or wound drainage is critical to prevent periprosthetic infection and its undesirable consequences.

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Available from: Javad Parvizi, Jan 25, 2014
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    • "Similar reports have been previously reported with the use of warfarin and unfractionated heparin36). Parvizi et al.39) reviewed 78 cases that underwent revision for septic failure and demonstrated a direct correlation between administration of excessive anticoagulation and development of periprosthetic infection. A mean international normalized ratio (INR) of greater than 1.5 was found to be more prevalent in patients who developed postoperative wound complications and subsequent periprosthetic infection. "
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    • "Increased pressure impairs blood flow and healing of the operative wound. Additionally, a hematoma is also a good culture medium for bacteria (Cheung et al., 2008; Parvizi et al., 2007). The function of phagocytic cells to eliminate these bacteria in hematoma is weakened. "

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