Is It Safe to Give Meloxicam or Celecoxib to Chronically Anticoagulated Patients Following Primary Total Knee Arthroplasty?

BACKGROUND

The nonsteroidal anti-inflammatory drugs (NSAIDs) are foundational components of multimodal pain protocols and have been shown to improve pain and range of motion following total knee arthroplasty (TKA). Patients receiving chronic anticoagulation therapy undergoing TKA are potentially disadvantaged because there are concerns with concurrent NSAID use due to bleeding concerns. Evidence suggests that cyclo-oxygenase 2 (Cox-2) inhibitors may not be associated with increased bleeding risk. The purpose of this study was to evaluate the safety of concurrent administration of NSAIDs in chronically anticoagulated patients undergoing primary TKA.

METHODS

Using an administrative claims database, we reviewed the records of 232,542 patients undergoing TKA between 2017 and 2021. Within this cohort, there were 2,299 patients who were chronically anticoagulated and 508 patients who were prescribed either celecoxib or meloxicam following TKA. The outcomes of interest included 30- and 90-day transfusion and readmission rates, rates of manipulation, and reoperations up to 180 days, and 30-, 90-, and 180-day opioid consumption measured as oral morphine equivalents between the two groups.

RESULTS

Concurrent administration of NSAIDs was not associated with increased risks for blood transfusions and readmissions at 30, 90, and 180 days. The administration of NSAIDs was associated with a decrease in manipulations without an increased risk for reoperations (odds ratio 0.48, confidence interval 0.28 to 0.82, P = 0.007). A modest reduction in 90 (9%, P = 0.038) and 180 (10%, P = 0.040) opioid prescriptions filled was observed in anticoagulated patients receiving NSAIDs following primary TKA.

CONCLUSIONS

Concurrent administration of COX-2 NSAIDs in chronically anticoagulated patients undergoing primary TKA was not associated with increased transfusions or readmissions. Patients receiving COX-2 inhibitors had a lower risk of manipulation and reduced opioid consumption at 90 days postoperatively. These results should be interpreted with caution, and if considering NSAID therapy in anticoagulated patients, they should be closely monitored.

LEVEL OF EVIDENCE: LEVEL III: Case Controlled Series.