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Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.

Publication ,  Journal Article
Hong, CS; Politzer, C; Ryan, SP; Wellman, SS; Jiranek, WA; Bolognesi, MP; Seyler, TM
Published in: Orthopedics
May 1, 2020

Venous thromboembolism and ischemic stroke are major complications following total knee arthroplasty (TKA) and potentially are associated with a patent foramen ovale (PFO). Although this association has been shown in other surgical disciplines, it has not been demonstrated in patients undergoing TKA. This study was undertaken to determine whether patients with a PFO would have a significantly increased risk of cerebrovascular accident (CVA) following TKA. The Humana national database was used to identify TKA patients who were stratified by the presence of a PFO from 2007 to 2016. Ninety-day follow-up was used for the primary outcome of CVA. Potential confounding comorbidities also were investigated, including age, sex, anticoagulation, insurance type, arrhythmia, valvular disease, peripheral vascular disease, chronic kidney disease, and diabetes mellitus. Of 153,245 TKAs, a total of 2272 patients had strokes; 479 of these patients had a PFO. On multivariable analysis, PFO remained an independent predictor of CVA postoperatively (odds ratio, 3.824; 95% confidence interval, 2.614-5.406; P<.0001). Other significant comorbidities associated with CVA included arrhythmia, chronic kidney disease, diabetes mellitus, peripheral vascular disease, and coronary valve disease. Importantly, low-molecular weight heparin or factor Xa inhibitor administration postoperatively had a negative correlation with stroke (odds ratio, 0.762; 95% confidence interval, 0.663-0.871; P=.0001 and odds ratio, 0.749; 95% confidence interval, 0.628-0.885; P=.0009, respectively). The findings of the multivariable analysis indicate PFO is associated with early postoperative CVA within 90 days following TKA. If known preoperatively, appropriate referral should be made to a cardiologist for PFO management and anticoagulation to reduce the overall risk of stroke. [Orthopedics. 2020;43(3):e151-e158.].

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Published In

Orthopedics

DOI

EISSN

1938-2367

Publication Date

May 1, 2020

Volume

43

Issue

3

Start / End Page

e151 / e158

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Stroke
  • Risk Factors
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Foramen Ovale, Patent
  • Female
  • Arthroplasty, Replacement, Knee
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hong, C. S., Politzer, C., Ryan, S. P., Wellman, S. S., Jiranek, W. A., Bolognesi, M. P., & Seyler, T. M. (2020). Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management. Orthopedics, 43(3), e151–e158. https://doi.org/10.3928/01477447-20200213-06
Hong, Cierra S., Cary Politzer, Sean P. Ryan, Samuel S. Wellman, William A. Jiranek, Michael P. Bolognesi, and Thorsten M. Seyler. “Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.Orthopedics 43, no. 3 (May 1, 2020): e151–58. https://doi.org/10.3928/01477447-20200213-06.
Hong CS, Politzer C, Ryan SP, Wellman SS, Jiranek WA, Bolognesi MP, et al. Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management. Orthopedics. 2020 May 1;43(3):e151–8.
Hong, Cierra S., et al. “Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.Orthopedics, vol. 43, no. 3, May 2020, pp. e151–58. Pubmed, doi:10.3928/01477447-20200213-06.
Hong CS, Politzer C, Ryan SP, Wellman SS, Jiranek WA, Bolognesi MP, Seyler TM. Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management. Orthopedics. 2020 May 1;43(3):e151–e158.

Published In

Orthopedics

DOI

EISSN

1938-2367

Publication Date

May 1, 2020

Volume

43

Issue

3

Start / End Page

e151 / e158

Location

United States

Related Subject Headings

  • Venous Thromboembolism
  • Stroke
  • Risk Factors
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Foramen Ovale, Patent
  • Female
  • Arthroplasty, Replacement, Knee