Preoperative Coagulation Markers and Clinical Predictors of Transfusion Requirement in Patients Undergoing Total Knee or Hip Arthroplasty: A Single-Center Retrospective Study

<b>Background/Objectives:</b> Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are widely performed procedures often associated with significant blood loss, leading to the need for allogeneic blood transfusion. Transfusions carry inherent risks and increase healthcare costs, making the identification of transfusion predictors crucial. This study aimed to assess preoperative predictors associated with transfusion requirement in patients undergoing THA or TKA. <b>Methods:</b> This single-center, retrospective analysis included 742 patients who underwent primary TKA or THA between 2016 and 2023. Preoperative variables such as hemoglobin, red blood cell count (RBC), INR, APTT, and use of tranexamic acid (TXA) were collected. Univariable and multivariable logistic regression analyses were conducted to identify independent predictors of transfusion. <b>Results:</b> Transfusions were required in 12.0% of patients. Multivariable analysis revealed that lower preoperative HGB and RBC levels, absence of TXA use, higher INR, and undergoing THA (versus TKA) were independently associated with increased transfusion risk. INR was not significant in univariable analysis but reached significance in the adjusted model. The final multivariable model demonstrated good predictive performance, with an area under the ROC curve (AUC) of 0.79. <b>Conclusions:</b> Lower hemoglobin and RBC levels, elevated INR, absence of TXA use, and THA surgery were independent predictors of transfusion. These findings may guide the use of routine preoperative hematologic and coagulation assessments to guide perioperative management and reduce transfusion rates in joint arthroplasty.