Key result
DAPT after elective THA or TKA did not increase 90-day bleeding but was associated with higher odds of stroke compared to clopidogrel alone (aOR 2.34; 95% CI 1.16-4.69; P=0.017).
Why the study?
Current guidelines regarding the safety of dual-antiplatelet therapy following primary elective total hip arthroplasty and total knee arthroplasty are unclear.
Does dual-antiplatelet therapy increase 90-day bleeding and thromboembolic complications compared to clopidogrel alone in patients undergoing primary elective total hip or knee arthroplasty?
Cohort (n=18,117)
Yes
Does dual-antiplatelet therapy increase 90-day bleeding and thromboembolic complications compared to clopidogrel alone in patients undergoing primary elective total hip or knee arthroplasty?
DAPT does not increase early postoperative bleeding complications compared to clopidogrel alone following elective THA or TKA, suggesting it may be safely resumed.
Stroke risk with DAPT post-THA/TKA warrants caution despite no bleeding increase; leaves open need for RCTs.
INTRODUCTION: Dual-antiplatelet therapy (DAPT), the combined administration of aspirin and clopidogrel, is commonly used to prevent thrombus formation in patients at an increased risk of thromboembolic complications. However, current guidelines regarding DAPT safety following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) are unclear. We sought to compare the odds of 90-day bleeding and thromboembolic complications among patients receiving DAPT relative to clopidogrel alone. METHODS: All patients who underwent primary TKA or THA between 2016 and 2021 were identified using the Premier Healthcare Database. Patients who received DAPT for postoperative thromboprophylaxis were compared with those receiving only clopidogrel for demographic and comorbidity differences. Chi-square analysis was employed to evaluate differences between categorical variables, whereas independent t -tests were used for continuous variables. Univariate and multivariable regression analyses were used to assess differences in 90-day outcomes. RESULTS: In total, 18,117 primary THA and TKA patients (DAPT: 83.0%; clopidogrel: 17.0%) were identified. After adjusting for confounders, DAPT patients did not demonstrate increased rates of bleeding complications, transfusion, acute anemia, hematoma, or hemorrhage compared with those receiving clopidogrel alone. In addition, no significant differences were found in rates of deep vein thrombosis, pulmonary embolism, myocardial infarction, or mortality between the cohorts. However, compared with patients receiving clopidogrel, those receiving DAPT were more likely to suffer stroke (adjusted odds ratio 2.34, 95% confidence interval: 1.16 to 4.69, P = 0.017). DISCUSSION: Despite the notable efficacy of DAPT in reducing thromboembolic risk, patients on DAPT did not have higher rates of postoperative bleeding complications within the early postoperative period following elective THA or TKA. These findings suggest that patients on long-term DAPT may safely resume these medications after THA or TKA.
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Telang et al. (2025) conducted a cohort in Primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) (n=18,117). Dual-antiplatelet therapy (DAPT) vs. Clopidogrel alone was evaluated on 90-day stroke (aOR 2.34, 95% CI 1.16-4.69, p=0.017). DAPT after elective THA or TKA did not increase 90-day bleeding but was associated with higher odds of stroke compared to clopidogrel alone (aOR 2.34; 95% CI 1.16-4.69; P=0.017).
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