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. 2025 Oct 7;23(1):91.
doi: 10.1186/s12959-025-00786-w.

Incidence, outcomes, and risk factors of Heparin-induced thrombocytopenia in patients undergoing primary and revision knee arthroplasty

TingJie Ren #  1 , MingCong Chen #  2 , QinFeng Yang #  3 , SiJia Xu #  1   4 , YuHang Chen  5   6 , Jian Wang  7 , XuanJian Fu  8
Affiliations

Incidence, outcomes, and risk factors of Heparin-induced thrombocytopenia in patients undergoing primary and revision knee arthroplasty

TingJie Ren et al. Thromb J. .

Abstract

Background: Heparin-induced thrombocytopenia (HIT) is a serious complication associated with heparin use in orthopedic surgery. However, its incidence and risk factors in total knee arthroplasty (TKA) and revision TKA (RTKA) remain unclear. This study aimed to evaluate how preoperative comorbidities, hospital characteristics, and patient demographics influence the incidence of HIT in patients who underwent TKA and RTKA. Differences in postoperative complications, mortality, hospital length of stay, HIT-related costs, and changes in HIT risk following revision surgery were examined.

Methods: This retrospective study examined data from the National Inpatient Sample (NIS) on patients with TKA and RTKA from 2010 to 2019, categorizing them by the incidence of HIT. Demographics (race, sex, and age) and hospital (admission type, insurance, hospital size, teaching status, and region) details were analyzed. Mortality, comorbidities, and perioperative complications were assessed, and logistic regression analyses were performed to identify potential risk factors.

Results: Pulmonary circulatory disorders were strongly associated with HIT in both TKA (P < 0.01, OR = 3.43) and RTKA (P < 0.01, OR = 4.13) groups. Teaching hospitals were associated with lower odds of HIT in the TKA group (P = 0.01, OR = 0.62). Risk factors in RTKA included valvular heart disease (OR = 2.50, 95% CI 1.12-5.57). Common complications among HIT cases included deep vein thrombosis, acute myocardial infarction, and acute renal failure. Pulmonary embolism, postoperative pneumonia, procedural pain, and prosthetic joint infection were more common in TKA group, whereas dyspnea was more prevalent in RTKA group.

Conclusions: Certain preoperative comorbidities and baseline characteristics are associated with increased HIT risk following TKA. RTKA is associated with higher odds of HIT and a greater incidence of adverse clinical outcomes. These findings may support the need for improved risk stratification and postoperative planning to reduce complications and enhance recovery.

Keywords: Heparin-induced thrombocytopenia; Revision of total knee arthroplasty; Total knee arthroplasty.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This article does not contain any studies with human participants or animalsperformed by any of the authors. Administrative permissions were required to access the raw data employed in this study, and the affiliation of co-authorhas already granted permission from the Agency for Healthcare Research and Quality(AHRQ)to access Healthcare Cost and Utilization Project (HUCP)Nationwide Databases. However, our observational study was deemed exempt bythe Ethics Committee of Nanfang Hospital of Southern Medical University forusing deidentified publicly available data. Besides, the data collected in ourstudy were unnecessary to be anonymized before its use. All methods werecarried out following relevant guidelines and regulations.. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study a: National Inpatient Sample Database; b: International Classification of Diseases-9/10; c: Total Knee Arthroplasty; d: Revision Total Knee Arthroplasty e: Heparin-Induced Thrombocytopenia; f:Venous Thromboembolism
Fig. 2
Fig. 2
The incidence of HIT after TKA and RTKA from 2010–2019. HIT: heparin-induced thrombocytopenia; TKA: total knee arthroplasty; RTKA: total knee arthropl
Fig. 3
Fig. 3
a. Forest plot of adjusted odds ratios for risk factors associated with HIT after total knee arthroplasty (2010–2019) b. Forest plot of adjusted odds ratios for risk factors associated with HIT after revision total knee arthroplasty (2010–2019)
See this image and copyright information in PMC

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