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News

Risk of GI bleeding after total hip or knee replacement 

A study in this month's issue of the American Journal of Gastroenterology evaluates the risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement vs matched controls.

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Gastrointestinal bleeding may impose a serious threat in patients undergoing total hip or knee replacement.

Dr Arief Lalmohamed and colleagues from the Netherlands evaluated the timing of gastrointestinal bleeding following total hip replacements/total knee replacement, and determined the effect modification by proton pump inhibitor use.
 
The research team undertook a nationwide Danish cohort study, and selected all patients with a primary total hip replacements/total knee replacement between 1998 and 2007.

The team matched 3 control subjects without total hip replacements/total knee replacement by age, sex, and region.

Proton pump inhibitor use was assessed in the previous 3 months.

PPI use lowered the hazard ratios for gastrointestinal bleeding by 74%
American Journal of Gastroenterology

The research team identified a 6-fold increased risk of gastrointestinal bleeding during the first 2 weeks following total hip replacements, and about a 2-fold increased risk for total knee replacement patients, both vs. matched controls.

The elevated risk lasted longer in total hip replacements patients as compared with total knee replacement patients.

Proton pump inhibitor use lowered the hazard ratios for gastrointestinal bleeding by 74% during the first 6 weeks following total hip replacements, but not total knee replacement.

Dr Lalmohamed's team concludes, "This study demonstrated an increased risk of gastrointestinal bleeding during the first 2 weeks following total hip replacements and total knee replacement, and remained increased for up to 6 to 12 weeks after surgery."

"Proton pump inhibitor use substantially lowered this elevated risk in total hip replacements patients, but not in total knee replacement patients."

Am J Gastroenterol 2013: 108: 1277–1285
16 August 2013

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