Comparative effectiveness of aspirin for symptomatic venous thromboembolism prophylaxis in patients undergoing total joint arthroplasty, a cohort study

Journal article


Sidhu, Verinder, Hawke, Helen, Churches, Tim, Naylor, Justine, Adie, Sam and Harris, Ian A.. (2023). Comparative effectiveness of aspirin for symptomatic venous thromboembolism prophylaxis in patients undergoing total joint arthroplasty, a cohort study. BMC Musculoskeletal Disorders. 24(1), pp. 1-8. https://doi.org/10.1186/s12891-023-06750-x
AuthorsSidhu, Verinder, Hawke, Helen, Churches, Tim, Naylor, Justine, Adie, Sam and Harris, Ian A.
Abstract

Background: This study compares the symptomatic 90-day venous thromboembolism (VTE) rates in patients receiving aspirin to patients receiving low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs), after total hip (THA) and total knee arthroplasty (TKA).

Methods: Data were collected from a multi-centre cohort study, including demographics, confounders and prophylaxis type (aspirin alone, LMWH alone, aspirin and LMWH, and DOACs). The primary outcome was symptomatic 90-day VTE. Secondary outcomes were major bleeding, joint related reoperation and mortality within 90 days. Data were analysed using logistic regression, the Student’s t and Fisher’s exact tests (unadjusted) and multivariable regression (adjusted).

Results: There were 1867 eligible patients; 365 (20%) received aspirin alone, 762 (41%) LMWH alone, 482 (26%) LMWH and aspirin and 170 (9%) DOAC. The 90-day VTE rate was 2.7%; lowest in the aspirin group (1.6%), compared to 3.6% for LMWH, 2.3% for LMWH and aspirin and 2.4% for DOACs. After adjusted analysis, predictors of VTE were prophylaxis duration < 14 days (OR = 6.7, 95% CI 3.5–13.1, p < 0.001) and history of previous VTE (OR = 2.4, 95% CI 1.1–5.8, p = 0.05). There were no significant differences in the primary or secondary outcomes between prophylaxis groups.

Conclusions: Aspirin may be suitable for VTE prophylaxis following THA and TKA. The comparatively low unadjusted 90-day VTE rate in the aspirin group may have been due to selective use in lower-risk patients.

Trial Registration: This study was registered at ClinicalTrials.gov, trial number NCT01899443 (15/07/2013).

KeywordsVenous thromboembolism; Arthroplasty; Aspirin; Low-molecular Weight Heparin; Novel oral anticoagulants
Year01 Jan 2023
JournalBMC Musculoskeletal Disorders
Journal citation24 (1), pp. 1-8
PublisherBioMed Central Ltd.
ISSN1471-2474
Digital Object Identifier (DOI)https://doi.org/10.1186/s12891-023-06750-x
Web address (URL)https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06750-x
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-8
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Print03 Aug 2023
Publication process dates
Accepted24 Jul 2023
Deposited12 Mar 2024
Additional information

© The Author(s) 2023.

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Trial Registration: This study was registered at ClinicalTrials.gov, trial number NCT01899443 (15/07/2013)

Place of publicationUnited Kingdom
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