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Timing of stroke in patients undergoing total hip replacement and matched controls: a nationwide cohort study

Timing of stroke in patients undergoing total hip replacement and matched controls: a nationwide cohort study
Timing of stroke in patients undergoing total hip replacement and matched controls: a nationwide cohort study
BACKGROUND AND PURPOSE: Stroke is a potentially fatal complication of total hip replacements (THR). However, timing of stroke in THR patients compared with matched controls and influence of drug use remain unknown. The objective of this study was to determine timing of stroke in patients with THR compared with matched control subjects.

METHODS: A nationwide cohort study was conducted within the Danish registers (1998-2007). Included patients were those with a primary THR in the study period (n=66,583) and were matched by age, sex, and region to three referent subjects without THR or total knee replacements. Time-dependent Cox models were used to derive hazard ratios and were adjusted for disease history and drug use.

RESULTS: A 4.7-fold increased risk of ischemic stroke (adjusted hazard ratio, 4.69; 95% CI, 3.12-7.06), and a 4.4-fold increased risk of hemorrhagic stroke (adjusted hazard ratio, 4.40; 95% CI, 2.01-9.62) were found within 2 weeks following THR, compared with matched controls. The risk remained elevated during the first 6 postoperative weeks for ischemic stroke, and the first 12 weeks for hemorrhagic stroke. Outpatient antiplatelet drug use lowered the 6-week hazard ratios for ischemic stroke by 70%, although not affecting risk of hemorrhagic stroke.

CONCLUSIONS: This study shows, that THR patients have a 4.7-fold increased risk of ischemic stroke, and a 4.4-fold increased risk of hemorrhagic stroke during the first 2 weeks postsurgery. Risk assessment of stroke in individual patients undergoing THR (ie, evaluate other risk factors for stroke) should be considered during the first 6 to 12 weeks.

0039-2499
3225-3229
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
Vestergaard, P.
b00ba0f8-a9b7-45f1-a0c7-579fec88b556
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
de Boer, A.
5621b588-a1e0-4827-8940-89efef278f13
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Lalmohamed, A.
b3bef1c3-1d0f-4e3d-b999-a00b16aff528
Vestergaard, P.
b00ba0f8-a9b7-45f1-a0c7-579fec88b556
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
de Boer, A.
5621b588-a1e0-4827-8940-89efef278f13
Leufkens, H.G.
6f387677-0ec5-408b-bdbc-7a50d49631b6
van Staa, T.P.
31b8bfb4-4e1b-4a48-a5a6-90ca601b94af
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1

Lalmohamed, A., Vestergaard, P., Cooper, C., de Boer, A., Leufkens, H.G., van Staa, T.P. and de Vries, Frank (2012) Timing of stroke in patients undergoing total hip replacement and matched controls: a nationwide cohort study. Stroke, 43 (12), 3225-3229. (doi:10.1161/?STROKEAHA.112.668509). (PMID:23132782)

Record type: Article

Abstract

BACKGROUND AND PURPOSE: Stroke is a potentially fatal complication of total hip replacements (THR). However, timing of stroke in THR patients compared with matched controls and influence of drug use remain unknown. The objective of this study was to determine timing of stroke in patients with THR compared with matched control subjects.

METHODS: A nationwide cohort study was conducted within the Danish registers (1998-2007). Included patients were those with a primary THR in the study period (n=66,583) and were matched by age, sex, and region to three referent subjects without THR or total knee replacements. Time-dependent Cox models were used to derive hazard ratios and were adjusted for disease history and drug use.

RESULTS: A 4.7-fold increased risk of ischemic stroke (adjusted hazard ratio, 4.69; 95% CI, 3.12-7.06), and a 4.4-fold increased risk of hemorrhagic stroke (adjusted hazard ratio, 4.40; 95% CI, 2.01-9.62) were found within 2 weeks following THR, compared with matched controls. The risk remained elevated during the first 6 postoperative weeks for ischemic stroke, and the first 12 weeks for hemorrhagic stroke. Outpatient antiplatelet drug use lowered the 6-week hazard ratios for ischemic stroke by 70%, although not affecting risk of hemorrhagic stroke.

CONCLUSIONS: This study shows, that THR patients have a 4.7-fold increased risk of ischemic stroke, and a 4.4-fold increased risk of hemorrhagic stroke during the first 2 weeks postsurgery. Risk assessment of stroke in individual patients undergoing THR (ie, evaluate other risk factors for stroke) should be considered during the first 6 to 12 weeks.

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Published date: December 2012
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 348272
URI: http://eprints.soton.ac.uk/id/eprint/348272
ISSN: 0039-2499
PURE UUID: 1398bbb5-cad4-401b-84d8-adbde702cc3e
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 11 Feb 2013 10:23
Last modified: 05 Nov 2019 01:59

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Contributors

Author: A. Lalmohamed
Author: P. Vestergaard
Author: C. Cooper ORCID iD
Author: A. de Boer
Author: H.G. Leufkens
Author: T.P. van Staa
Author: Frank de Vries

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