External iliac artery injury following total hip arthroplasty via the direct anterior approach—a case report

An 82-year old man attended our outpatient clinic with symptoms of osteoarthritis of the right hip. Radiographic examination confirmed this diagnosis.

The patient’s medical history included: atrial fibrillation, for which a coumarin derivate was started in 2009, idiopathic thrombocytopenia, with platelet counts of circa 60 × 10⁹ (normal 150–400 × 10⁹), and prostate carcinoma. After transurethral prostate resection in 2016, at the request of the patient, anticoagulant treatment was replaced by ASA (Ascal). Moreover, despite suffering from atrial fibrillation and a low ventricular rate, the patient had chosen not to receive a pacemaker. Ascal was discontinued 7 days before the planned total hip arthroplasty (THA). Therapy to increase platelet function was not administered preoperatively because of low risk of bleeding associated with platelet counts > 30 × 10⁹ (Yang and Zhong 2000).