Cardiovascular therapy in patients hospitalized for elective large joint arthroplasty: real-world practice review

Background. The patients who require major lower limb joint replacement have a high prevalence of comorbidities, particularly hypertension. Also, they are mostly elderly, with concomitant obesity, chronic kidney disease, poor glycemic control, etc. These factors individually and collectively increase the risk of complications in the perioperative period.

Aim. To study the features of preoperative drug therapy for cardiovascular diseases considering the indications in patients hospitalized for elective major lower limb joint replacement.

Materials and methods. The study included an unselected sample of patients, 41 males and 77 females (n=118). The mean age was 64.7±11.1 years, and the mean body mass index was 30.7±4.9 kg/m². All patients had a detailed history, an examination with blood pressure measurement, and their therapy for cardiovascular diseases was analyzed. Of 118 patients, 88 (74.6%) had hypertension, 68 (77.2%) received angiotensin-converting enzyme inhibitors, 20 (22.8%) angiotensin receptor blockers, 17 (19.3%) calcium channel blockers combined with other antihypertensive drugs, 11 (12.5%) had no antihypertensive therapy before hospitalization, despite a recorded high blood pressure for several years.

Results. The routine preoperative outpatient examination included lipid profile in 77 (65.3%) patients, most of whom had total cholesterol only (66 had levels above normal); low-density lipoprotein levels were measured in only 14 (11.9%) patients, and 9 had levels above target for the relevant risk group. Statins were previously prescribed to only 18 (15.3%) patients. Twenty-two (18.6%) patients reported taking acetylsalicylic acid, with only 7 according to indications; 5 (4.2%) received clopidogrel, of which 1 patient had no indications.

Conclusion. Most of the study patients had hypertension of varying severity. Some patients received suboptimal antihypertensive therapy and, in some cases, previously prescribed antihypertensive drug combinations not complying with relevant guidelines. Most patients with hypercholesterolemia did not receive statins with no rationale for not prescribing this class of drugs. Some patients received antiplatelet agents with no appropriate indications.