The Association Between Intraoperative Heparin and Postoperative Thrombotic Complications after Total Hip and Knee Arthroplasty: A Retrospective Analysis

BACKGROUND: Thrombotic complications cause morbidity after total joint arthroplasty (TJA). Historically, some surgeons used intraoperative intravenous heparin to reduce thrombosis, but the evidence is outdated. We hypothesized that in modern TJA, intravenous heparin would not be associated with fewer thrombotic complications. METHODS: Patients who underwent primary total hip and total knee arthroplasty (THA and TKA, respectively) at a single center from 2017 to 2024 were included in this retrospective cohort study. The primary outcome was composite thrombotic complications at 90 days, including deep vein thrombosis, pulmonary embolism, myocardial infarction, and cerebrovascular accident. The secondary outcomes included 30-day complications, intraoperative blood losses, and red blood cell transfusions. The outcome was analyzed with propensity score-matched multivariable logistic regressions based on intravenous heparin administration as a binary variable. The model was controlled for clinically relevant covariates. A total of 3,132 THA and 3,407 TKA patients were identified. After propensity score matching, we identified nine of 921 heparin (1%) and five of 900 (0.6%) no-heparin THA patients and 14 of 1,397 heparin (1%) and 15 of 1,319 (1%) no-heparin TKA patients who experienced a thrombotic event. RESULTS: There was no association between heparin and 90-day thrombotic complications for THA (odds ratio 1.873; 95% confidence interval, 0.604 to 5.812; P = 0.277) or TKA (odds ratio 0.775; 95% confidence interval, 0.357 to 1.684; P = 0.520). Intraoperative blood losses were greater in the no-heparin groups for both THA and TKA cohorts; patients in the no-heparin group in the TKA cohort received more transfused units of packed red blood cells than those in the heparin group, but there was no difference between groups in the THA cohort. CONCLUSIONS: Intraoperative intravenous heparin was not associated with a reduction in thrombotic complications, and its routine use in primary TJA is not supported by this study.