JOA - 2026-05-07 - Journal Article
The Effect of Concomitant Use of Potent Anticoagulants and Anti-Inflammatories on the Early Outcomes of Total Hip Arthroplasty.
Gonzalez AG, Weinblatt AI, Jones AC, Lan R, Lyman S, Hwang R, Anatone AJ, Marega CL, Chalmers BP, Della Valle AG
Topics
Key Takeaway
Concomitant NSAID use in anticoagulated THA patients was associated with a 4.57-point reduction in 6-week pain scores (95% CI -7.82 to -1.31) without increasing VTE, wound complications, readmission, or reoperation rates.
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Summary
This study asked whether concomitant NSAID use in anticoagulated primary THA patients increases bleeding-related complications or alters pain and opioid outcomes. Among 2,984 patients receiving ≥14 days postoperative anticoagulation, 1,285 received NSAIDs and 1,699 did not; IPTW-weighted regression showed NSAID use reduced 6-week pain scores by 4.57 points with no significant difference in VTE, MI, wound complications, readmission, or reoperation. Notably, among patients who required reoperation, the control group had a significantly higher rate of subsequent reoperation within 90 days (32.1% vs 10.0%, P=0.021).
Key Limitation
NSAID agent, dose, and duration are not characterized, making it impossible to determine whether findings apply uniformly across NSAID classes or are driven by a specific drug or regimen.
Original Abstract
BACKGROUND
Concomitant use of non-steroidal 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.
METHODS
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 and 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 (BMI), 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.
RESULTS
The six-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% CI [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).
CONCLUSION
In this observational cohort, concomitant 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. These findings are hypothesis-generating and warrant further study.