50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

•Thrombotic complications (DVT, PE, MI, and CVA) can increase mortality in total joint arthroplasty (TJA)

•Intraoperative IV heparin has been used to reduce these complications, but literature has been inconsistent

•We hypothesized that heparin would not reduce 90-day postoperative thrombotic complications

•After IRB approval, all primary TJA (total knee arthroplasty (TKA) and total hip arthroplasty (THA)) procedures from April 1, 2017 - April 1, 2024, were identified from the EMR

•Complications were identified using a prospectively collected nurse navigator database that used phone calls at 30 and 90 days

•Propensity score matching (PSM) obtained standard mean differences < 0.10 using nearest neighbor method

•Univariate analyses: Student t test or Mann Whitney U test used for continuous variables; chi square used for categorical variables w/ p<0.05 for statistical significance

•Logistic regression used to test association between heparin and composite thrombotic complications (DVT, PE, MI, CVA)

•After PSM, the groups were well matched except for greater EBL in no heparin groups and greater mean number of PRBCs in no heparin (TKA only; Table 1)

•TKA: 3,407 patients identified (2,010 no heparin and 1,397 heparin); PSM resulted in 1,334 no heparin and 1,397 heparin

•Univariate analysis: DVT at 30 days occurred in 0.4% of no heparin and 0% heparin groups; p=0.028 (Table 2)

•Multivariate analysis: heparin did not reduce 90-day thrombotic cx: OR 0.770 (95% CI 0.362 – 1.639; p=0.497)

•THA: 3,132 patients identified (2,211 no heparin and 921 heparin); PSM resulted in 900 no heparin and 921 heparin

•Univariate analysis: no differences in all cx (Table 2)

•Multivariate analysis: heparin did not reduce 90-day thrombotic cx: OR 1.972 (95% CI 0.625 – 6.222; p=0.247)

•This study found that heparin was not associated with a reduction in 90-day thrombotic complications

•Our results expand upon previous studies through the inclusion of additional complications and by extending results to 90 days

•Limitations include the single hospital, the inclusion of multiple surgeons, and possible unreported complications

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

THE ASSOCIATION BETWEEN INTRAOPERATIVE HEPARIN AND POSTOPERATIVE THROMBOTIC COMPLICATIONS AFTER TJA: A RETROSPECTIVE ANALYSIS

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