Preoperative Platelet and International Normalized Ratio Thresholds and Their Impact on Complications Following Revision Total Joint Arthroplasty

This retrospective database study looked at patients undergoing revision total hip or knee arthroplasty and asked whether preoperative platelet counts and INR values below the traditional 'safe' thresholds (platelets ≥50,000/μL, INR <1.5) were linked to more complications. After propensity matching, patients with platelets 50,000-100,000/μL had nearly double the odds of needing a blood transfusion at 90 days (OR 1.88, 95% CI 1.45-2.44) along with higher odds of periprosthetic joint infection and 2-year mortality; mild INR elevation (1.1-1.5) and higher INR levels were also linked to more transfusions, thromboembolic events, infection, and in some groups mortality, though the risk did not rise in a clean stepwise fashion with higher INR.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersSurgeons often use platelet and INR cutoffs to decide who is 'safe' for revision arthroplasty, and this study suggests those thresholds may be too lenient, particularly for infection and transfusion risk.

Presenting this at rounds? Start here

• ?Should surgeons delay or further optimize revision arthroplasty candidates with platelet counts between 100,000 and 150,000/μL, a range currently considered 'normal' but here linked to higher transfusion, PJI, and mortality risk?
• ?Given that INR elevations above 1.5 did not show a stepwise increase in complications, how should surgeons weigh the risks of interrupting anticoagulation for reversal versus proceeding with a mildly elevated INR in revision arthroplasty patients?