JAAOS - 2026-05-15 - Journal Article
Dual-Antiplatelet Therapy Is Not Associated With Greater Odds of Postoperative Bleeding Following Elective Total Joint Arthroplasty.
Telang S, Palmer R, Aron A, Stronach BM, Stambough JB, Lieberman JR, Heckmann ND
Topics
Key Takeaway
DAPT following primary THA/TKA was not associated with increased 90-day bleeding versus clopidogrel alone, but carried a 2.34x higher adjusted odds of stroke (95% CI 1.16–4.69).
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Summary
This study compared 90-day bleeding and thromboembolic outcomes in primary THA/TKA patients receiving DAPT (aspirin + clopidogrel, 83%) versus clopidogrel alone (17%) using the Premier Healthcare Database (2016–2021). On multivariable regression, DAPT was not associated with increased rates of transfusion, acute anemia, hematoma, hemorrhage, DVT, PE, MI, or mortality. However, DAPT patients had significantly higher odds of stroke (aOR 2.34, 95% CI 1.16–4.69, P=0.017).
Key Limitation
Confounding by indication is uncontrolled—the stroke signal likely reflects the higher baseline cerebrovascular risk profile of patients prescribed DAPT rather than a causal drug effect, and the database cannot distinguish this.
Original Abstract
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.