Does Aspirin Have a Role in Venous Thromboembolism Prophylaxis in Total Knee Arthroplasty Patients?

Overview

Journal J Arthroplasty

Specialty Orthopedics

Date 2009 Aug 15

PMID 19679434

Citations 40

Authors

Kevin J Bozic

Thomas P Vail

Penelope S Pekow

Judith H Maselli

Peter K Lindenauer

Andrew D Auerbach

Affiliations

Soon will be listed here.

Abstract

The objectives of this study were to compare the risk of venous thromboembolism (VTE), bleeding, surgical site infection, and mortality in patients receiving aspirin or guideline-approved VTE prophylactic therapies (warfarin, low-molecular-weight heparins, synthetic pentasaccharides) in total knee arthroplasty (TKA). We analyzed clinical and administrative data from 93,840 patients who underwent primary TKA at 307 US hospitals over a 24-month period. Fifty-one thousand nine hundred twenty-three (55%) patients received warfarin, 37,198 (40%) received injectable agents, and 4719 (5%) received aspirin. After adjustment for patient and hospital factors, patients who received aspirin VTE prophylaxis (VTEP) had lower odds for thromboembolism compared to warfarin patients but with similar odds compared with injectable VTEP; there were no differences in risk of bleeding, infection, or mortality after adjustment. Our results suggest that aspirin, when used in conjunction with other clinical care protocols, may be effective VTEP for certain TKA patients.

Citing Articles

Low-versus high-dose aspirin for venous thromboembolic prophylaxis after total joint arthroplasty: a systematic review and meta-analysis.

Mirghaderi P, Pahlevan-Fallahy M, Rahimzadeh P, Habibi M, Pourjoula F, Azarboo A J Orthop Surg Res. 2024; 19(1):848.

PMID: 39702480 PMC: 11657554. DOI: 10.1186/s13018-024-05356-w.

Comparative efficacy of aspirin versus direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty: A systematic review and meta-analysis of randomised controlled trials.

Syed F, Amin H, Benjamin B, Hendrix M, Savaridas T J Exp Orthop. 2024; 11(3):e70010.

PMID: 39224751 PMC: 11366972. DOI: 10.1002/jeo2.70010.

Aspirin or enoxaparin for VTE prophylaxis after primary partial, total or revision hip or knee arthroplasty: A secondary analysis from the CRISTAL cluster randomized trial.

PLoS One. 2024; 19(4):e0298152.

PMID: 38626226 PMC: 11020928. DOI: 10.1371/journal.pone.0298152.

Venous thromboembolism testing practices after orthopaedic trauma: prophylaxis regimen does not influence testing patterns.

Haac B, OHara N, Haut E, Manson T, Slobogean G, OToole R OTA Int. 2024; 7(2):e331.

PMID: 38623266 PMC: 11013691. DOI: 10.1097/OI9.0000000000000331.

Therapeutic management of ischemic stroke.

Bindal P, Kumar V, Kapil L, Singh C, Singh A Naunyn Schmiedebergs Arch Pharmacol. 2023; 397(5):2651-2679.

PMID: 37966570 DOI: 10.1007/s00210-023-02804-y.

References

Laskin R . Minimally invasive total knee replacement using a mini-mid vastus incision technique and results. Surg Technol Int. 2005; 13:231-8. View

Schiff R, Kahn S, Shrier I, Strulovitch C, Hammouda W, Cohen E . Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis. Chest. 2005; 128(5):3364-71. DOI: 10.1378/chest.128.5.3364. View

Burnett R, Clohisy J, Wright R, McDonald D, Shively R, Givens S . Failure of the American College of Chest Physicians-1A protocol for lovenox in clinical outcomes for thromboembolic prophylaxis. J Arthroplasty. 2007; 22(3):317-24. DOI: 10.1016/j.arth.2007.01.007. View

. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000; 355(9212):1295-302. View

McCarthy E, Iezzoni L, Davis R, Palmer R, Cahalane M, Hamel M . Does clinical evidence support ICD-9-CM diagnosis coding of complications?. Med Care. 2000; 38(8):868-76. DOI: 10.1097/00005650-200008000-00010. View

Geerts W, Pineo G, Heit J, Bergqvist D, Lassen M, Colwell C . Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126(3 Suppl):338S-400S. DOI: 10.1378/chest.126.3_suppl.338S. View

Lotke P, Lonner J . The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res. 2006; 452:175-80. DOI: 10.1097/01.blo.0000238822.78895.95. View

Berend K, Lombardi Jr A . Multimodal venous thromboembolic disease prevention for patients undergoing primary or revision total joint arthroplasty: the role of aspirin. Am J Orthop (Belle Mead NJ). 2006; 35(1):24-9. View

Platt R, Yokoe D, Sands K . Automated methods for surveillance of surgical site infections. Emerg Infect Dis. 2001; 7(2):212-6. PMC: 2631728. DOI: 10.3201/eid0702.010212. View

10.

Lawthers A, McCarthy E, Davis R, Peterson L, Palmer R, Iezzoni L . Identification of in-hospital complications from claims data. Is it valid?. Med Care. 2000; 38(8):785-95. DOI: 10.1097/00005650-200008000-00003. View

11.

Pandit H, Aslam N, Pirpiris M, Jinnah R . Total knee arthroplasty: the future. J Surg Orthop Adv. 2006; 15(2):79-85. View

12.

Brookenthal K, Freedman K, Lotke P, Fitzgerald R, Lonner J . A meta-analysis of thromboembolic prophylaxis in total knee arthroplasty. J Arthroplasty. 2001; 16(3):293-300. DOI: 10.1054/arth.2001.21499. View

13.

Westrich G, Sculco T . Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg Am. 1996; 78(6):826-34. DOI: 10.2106/00004623-199606000-00004. View

14.

Seon J, Song E, Yoon T, Park S, Bae B, Cho S . Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg. 2007; 12(3):189-93. DOI: 10.3109/10929080701311861. View

15.

Jones C, Beaupre L, Johnston D, Suarez-Almazor M . Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1):71-86. DOI: 10.1016/j.rdc.2006.12.008. View

16.

Elixhauser A, Steiner C, Harris D, Coffey R . Comorbidity measures for use with administrative data. Med Care. 1998; 36(1):8-27. DOI: 10.1097/00005650-199801000-00004. View

17.

Lotke P, PALEVSKY H, Keenan A, Meranze S, STEINBERG M, Ecker M . Aspirin and warfarin for thromboembolic disease after total joint arthroplasty. Clin Orthop Relat Res. 1996; (324):251-8. DOI: 10.1097/00003086-199603000-00031. View

18.

Scuderi G . Preoperative planning and perioperative management for minimally invasive total knee arthroplasty. Am J Orthop (Belle Mead NJ). 2006; 35(7 Suppl):4-6. View

19.

McKenna R, Bachmann F, Kaushal S, Galante J . Thromboembolic disease in patients undergoing total knee replacement. J Bone Joint Surg Am. 1976; 58(7):928-32. View

20.

Harris W, Salzman E, Athanasoulis C, Waltman A, DESANCTIS R . Aspirin prophylaxis of venous thromboembolism after total hip replacement. N Engl J Med. 1977; 297(23):1246-9. DOI: 10.1056/NEJM197712082972302. View