The risks of pulmonary embolism and upper gastrointestinal bleeding beyond 35 days after total hip replacement for coxarthrosis among middle-aged patients: A cross-over cohort

Abstract Prophylactic anticoagulation is recommended up to 35 days after total hip replacement (THR). Although several observational studies have assessed the incidence of thrombotic events or bleeding events after THR, the corresponding measures of association have never been studied concomitantly. Here, we evaluated the duration of the elevated risks (relative to the baseline risk) of both venous thromboembolic events and bleeding events after THR for coxarthrosis among middle-aged patients. This was a population-based, cross-over cohort study of data extracted from the French national inpatient database between 2007 and 2013. We included middle-aged patients (aged 45 to 69) having undergone THR for coxarthrosis. We compared the numbers of pulmonary embolisms (PEs) (respectively upper gastrointestinal bleedings (UGIBs)) following the THR with the numbers occurring during three unexposed periods one year later. This enabled us to estimate the odds ratio (OR) [95% confidence interval (CI)] for each of six successive 35-day intervals. The study included 108,099 patients. The ORs for PE were respectively 12.4 (95% CI, 8.6–17.8) (absolute risk difference rate per 100,000 (ARD/100,000) = 130) and 5.0 (95% CI, 3.4–7.4) (ARD/100,000 = 52) for the first two 35-day intervals, and the risk was close to 1 thereafter. The risk of UGIB fell quickly, with an OR of 6.5 (95% CI, 4.6–9.1) (ARD/100,000 = 83) and 0.8 (95% CI, 0.4–1.6) for the first two 35-day intervals, respectively. The majority of UGIBs occurred during the inpatient stay for THR. Among middle-aged patients, the risk of a PE remains elevated beyond 35 days after THR for coxarthrosis, whereas the risk of a UGIB remains elevated for the first 35 days only.