The Effect of Concomitant Use of Potent Anticoagulants and Anti-Inflammatories on the Early Outcomes of Total Hip Arthroplasty.

Abstract

Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) in anticoagulated patients following total hip arthroplasty (THA) raises concerns about increased bleeding and related complications. This study evaluated postoperative pain, opioid consumption, and complications in anticoagulated THA patients who did and did not use concomitant NSAIDs. We retrospectively identified 2,984 patients who underwent primary THA for osteoarthritis between 2016 and 2023 at a single high-volume center and received at least 14 days of postoperative anticoagulation. Outcomes were compared between a study group of 1,285 patients (43%) who received concomitant NSAIDs and a control group of 1,699 patients (57%) who did not. Outcomes included 6-week pain scores, 90-day opioid use, wound complications, readmission, and reoperation. The primary analysis used inverse probability of treatment weighting (IPTW) based on the propensity score to balance baseline covariates in multivariable regression models. The propensity score was estimated from a logistic regression model with group assignment (study versus control) as the outcome and age, sex, body mass index, comorbidity burden, surgical year, and other clinical factors that influence outcomes or group assignment as predictors. Standardized mean differences were used to assess covariate balance. A 1:1 propensity score-matched analysis was performed as a sensitivity analysis. The 6-week pain scores were significantly lower in the study group in univariate analysis (14.9 ± 17.8 versus 18.3 ± 20.0; P = 0.009). In IPTW-weighted linear regression, concomitant NSAID use was associated with lower 6-week pain scores (difference: -4.57; 95% confidence interval: -7.82 to -1.31; P = 0.006). There were no significant differences in 90-day opioid use, venous thromboembolism, myocardial infarction, wound complications, readmission, or reoperation. Among patients requiring reoperation, the control group had a significantly higher rate of additional reoperation within 90 days (32.1 versus 10.0%; P = 0.021). In this observational cohort, concomitant, judicious NSAID use was associated with lower 6-week pain scores in IPTW-weighted analyses and was not associated with higher rates of complications, readmission, or reoperation.