Decreased venous thromboembolism with injectable vs oral anticoagulation after discharge for major orthopedic surgery

J Arthroplasty. 2008 Sep;23(6 Suppl 1):25-30. doi: 10.1016/j.arth.2008.05.017.


The use of outpatient anticoagulation after major orthopedic surgery with oral or injectable anticoagulants is recommended by national guidelines. A retrospective analysis of medical and pharmacy claims data using the PharMetrics Patient-Centric Database Inc, Watertown, Mass, was conducted. After adjusting for covariates, patients receiving warfarin were approximately 30% more likely to experience a venous thromboembolism than those receiving an injectable anticoagulant (6.3% vs 4.8%; adjusted odds ratio, 1.3; 95% confidence interval, 1.1-1.5) by 30 days. The data at 90 days showed similar results. No significant differences in the incidence of major bleeding events between the cohorts were observed (incidence of major bleed <0.4%). These findings support the randomized controlled studies and expand the data to the real-world perspective. Clinicians should evaluate these data alongside the clinical trial data when selecting the safest and most effective prophylactic therapy for postdischarge anticoagulation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Arthroplasty
  • Female
  • Hemorrhage / chemically induced
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Orthopedic Procedures*
  • Patient Discharge
  • Postoperative Complications / prevention & control
  • Pulmonary Embolism / prevention & control
  • Retrospective Studies
  • Venous Thromboembolism / prevention & control*
  • Warfarin / administration & dosage


  • Anticoagulants
  • Warfarin