JOA - 2026-09-21 - Journal Article
The Safety of Postoperative Selective Cyclooxygenase-2 Inhibitors in Chronically Anticoagulated Patients Undergoing Primary Total Hip Arthroplasty.
Tummala S, Valencia A, Chen AF, Bounajem G, Sambandam SN
Topics
Key Takeaway
In chronically anticoagulated patients undergoing primary THA, postoperative COX-2 inhibitor use was not associated with increased bleeding or renal complications and reduced 30-day opioid utilization by 43% (RR 0.567, P<0.001).
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Summary
This study asked whether postoperative COX-2 inhibitors (celecoxib or meloxicam) are safe in chronically anticoagulated patients undergoing primary THA, using propensity-score matched cohorts from a national database. No significant differences were found in transfusion, readmission, reoperation, DVT, AKI, or ED utilization at 30, 90, or 180 days. COX-2 recipients had nominally lower PE rates at 180 days (RR 0.46, P=0.012) and significantly lower opioid use at all timepoints (30-day RR 0.567, 90-day RR 0.633, 180-day RR 0.701; all P<0.001).
Key Limitation
The database design cannot confirm anticoagulant class, therapeutic range, or COX-2 dosing regimen, making it impossible to determine whether findings apply uniformly across warfarin, DOAC, and LMWH-anticoagulated patients.
Original Abstract
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs), particularly selective cyclooxygenase-2 (COX-2) inhibitors, are foundational to multimodal pain management following primary total-hip arthroplasty (THA) but concerns regarding bleeding often limit their use in patients receiving chronic anticoagulation. While data support COX-2 inhibitor safety following total knee arthroplasty in this population, THA-specific evidence remains limited.
METHODS
Utilizing a national database, patients undergoing primary THA on chronic anticoagulation between 2015 and 2025 were identified and stratified by postoperative exposure to selective COX-2 inhibitors (celecoxib or meloxicam). Propensity-score matching, which included preoperative anemia and history of acute kidney injury as covariates, balanced demographic and clinical characteristics between groups. The primary outcomes were blood transfusion and readmission at cumulative 30, 90, and 180 days postoperatively. Secondary outcomes included reoperation, periprosthetic dislocation, deep vein thrombosis, pulmonary embolism, acute kidney injury, emergency department utilization, and cumulative opioid use through 180 days.
RESULTS
The COX-2 inhibitor use was not associated with elevated rates of transfusion, inpatient readmission, reoperation, periprosthetic dislocation, deep vein thrombosis, acute kidney injury, or emergency department utilization at any timepoint (all P > 0.05). Pulmonary embolism was directionally lower in the COX-2 cohort, reaching nominal significance at 180 days (relative risk (RR) 0.46, P = 0.012). The COX-2 inhibitor recipients demonstrated lower cumulative opioid use at 30 days (9.84 versus 17.35%; RR:0.567, P < 0.001), 90 days (11.89 versus 18.78%; RR:0.633, P < 0.001), and 180 days (15.33 versus 21.88%; RR:0.701, P < 0.001) compared with patients not receiving COX-2 inhibitors.
CONCLUSIONS
In chronically anticoagulated patients undergoing primary THA, postoperative COX-2 inhibitor use was not associated with increased bleeding, readmission, renal, or surgical complications and was associated with lower cumulative postoperative opioid utilization. These observational findings support cautious COX-2 inhibitor use within multimodal analgesia in this population; however, future prospective studies are warranted to validate these findings.