Increased Risk of Venous Thromboembolism After Total Joint R
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Antiretroviral therapy has improved the life expectancy of HIV patients, leading to an increase in total joint replacement for age-related osteoarthritis. The goal of this study was to compare the incidence of venous thromboembolism (VTE) in HIV patients with HIV-negative controls after total joint replacement.

Study included 110 HIV patients (85 hips and 25 knees) and 240 HIV-negative controls (180 hips and 85 knees) . Prophylactic anticoagulation was used in 98% of patients postoperatively—low-molecular weight heparin (73%), warfarin (19%), aspirin (6%), and clopidogrel (1%).

Results:
--The VTE rate was 3.6% in the HIV-positive group and 0.4% in the control group.

--VTEs occurred at the median (interquartile range) time of 40 days post-op in the HIV group and 3 days post-op in the one control.

--Multivariable logistic regression adjusting for sex, smoking, history of VTE, and joint replaced identified HIV as an independent predictor of VTE.

--All patients with VTE were treated with warfarin (5 to 9 months); two cases were complicated by hemarthrosis and excessive bleeding at the insulin injection site.

In conclusion, symptomatic VTE was found to be more common in HIV patients after THA (2.5%) and TKA (8%), compared to HIV-negative control patients (0 % and 1.7 %, respectively). The presence of HIV was discovered to be an independent predictor of perioperative VTE. In HIV-positive patients, surgeons may want to consider using more potent anticoagulants (such as warfarin or new anticoagulants) for a longer period of time.

Source: https://journals.lww.com/jaaos/Abstract/2021/06010/HIV_Positive_Patients_Are_at_Increased_Risk_of.7.aspx
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