BACKGROUND AND PURPOSE Results regarding the impact of anticoagulants on revision rate are conflicting. We examined the association between the use of low molecular weight heparin (LMWH) or non-vitamin K oral anticoagulants (NOACs) as thromboprophylaxis after primary total hip arthroplasty (THA) and the revision rate due to infection, aseptic loosening, and all causes. PATIENTS AND METHODS We conducted a cohort study (n = 53,605) based on prospectively collected data from the national hip arthroplasty registries from Denmark and Norway. The outcome was time to revision due to infection, aseptic loosening, and all causes, studied separately. Kaplan-Meier (KM) survival analysis and a Cox proportional hazard model was used to estimate implant survival and cause-specific hazard ratios (HRs) with 95% confidence intervals (CI) adjusting for age, sex, Charlson Comorbidity Index, fixation type, start, and duration of thromboprophylaxis, and preoperative use of Vitamin K antagonists, NOAC, aspirin, and platelet inhibitors as confounders. RESULTS We included 40,451 patients in the LMWH group and 13,154 patients in the NOAC group. Regarding revision due to infection, the 1-year and 5-year KM survival was 99% in both the LMWH group and in the NOAC group. During the entire follow-up period, the adjusted HR for revision due to infection was 0.9 (CI 0.7-1.1), 1.6 (CI 1.3-2.1) for aseptic loosening, and 1.2 (CI 1.1-1.4) for all-cause revision for the NOAC compared with the LMWH group. The absolute differences in revision rates between the groups varied from 0.2% to 1%. INTERPRETATION Compared with LMWH, NOACs were associated with a slightly lower revision rate due to infection, but higher revisions rates due to aseptic loosening and all-cause revision. The absolute differences between groups are small and most likely not clinically relevant. In addition, the observed associations might partly be explained by selection bias and unmeasured confounding, and should be a topic for further research.

中文翻译：

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围手术期血栓预防与初次全髋关节置换术中因感染和无菌性松动引起的翻修率的关联——来自北欧关节置换术登记协会 (NARA) 的新证据。

背景和目的 关于抗凝剂对翻修率影响的结果是相互矛盾的。我们研究了初次全髋关节置换术 (THA) 后使用低分子肝素 (LMWH) 或非维生素 K 口服抗凝剂 (NOAC) 预防血栓形成与因感染、无菌性松动和所有原因导致的翻修率之间的关联。患者和方法 我们根据从丹麦和挪威的国家髋关节置换术登记处前瞻性收集的数据开展了一项队列研究 (n = 53,605)。结果是由于感染、无菌性松动和所有原因导致的修复时间，分别进行了研究。Kaplan-Meier (KM) 生存分析和 Cox 比例风险模型用于估计种植体生存和特定原因风险比 (HR)，其中 95% 置信区间 (CI) 根据年龄、性别、Charlson 合并症指数、固定类型、血栓预防的开始和持续时间，以及术前使用维生素 K 拮抗剂、NOAC、阿司匹林和血小板抑制剂作为混杂因素。结果 我们在 LMWH 组中纳入了 40,451 名患者，在 NOAC 组中纳入了 13,154 名患者。关于感染引起的翻修，LMWH 组和 NOAC 组的 1 年和 5 年 KM 存活率为 99%。在整个随访期间，因感染进行翻修的调整后 HR 为 0.9 (CI 0.7-1.1)，无菌性松动为 1.6 (CI 1.3-2.1)，全因翻修为 1.2 (CI 1.1-1.4) NOAC 与 LMWH 组相比。组间翻修率的绝对差异从 0.2% 到 1% 不等。解释 与 LMWH 相比，NOACs 与因感染引起的翻修率略低相关，但由于无菌松动和全因翻修，翻修率更高。组间的绝对差异很小，很可能与临床无关。此外，观察到的关联可能部分是由选择偏差和未测量的混杂因素解释的，应该成为进一步研究的主题。