Noninferiority of low-intensity to standard-intensity warfarin in geriatric hip or knee arthroplasty .
Effect of Low-Intensity vs Standard-Intensity Warfarin Prophylaxis on Venous Thromboembolism or Death Among Patients Undergoing Hip or Knee Arthroplasty: A Randomized Clinical Trial
JAMA. 2019 Sep 3;322(9):834-842.1650 elderly patients undergoing a hip or knee arthroplasty were randomized to receive a low-intensity dose (International Normalized Ratio (INR) = 1.8) or standard-intensity dose (INR = 2.5) of warfarin for the prevention of thromboembolic events. The primary outcome of interest was the composite outcome of VTE and death. Secondary outcomes of interest included the rate of major bleeding and the proportion of patients with a INR greater or equal to 4. Follow up was performed for up to 90 days post-surgery. The results revealed no significant difference between groups in the composite outcome of VTE and death, however this did not meet the criteria for non-inferiority. No significant difference in the rate of major bleeding was observed between the two groups. The proportion of patients with INR => 4 was significantly higher in the standard-intensity warfarin group.
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