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Aspirin was at least as good for preventing venous thromboembolism (VTE) after total knee replacement surgery as anticoagulant drugs such as warfarin, low molecular weight heparin, and the newer oral ...
Summary
- Among more than 40,000 patients in a statewide arthroplasty registry from 2013 to 2015, unadjusted rates of a composite VTE outcome were 1.16% for those receiving prophylaxis with aspirin alone, versus 1.42% for those receiving only other antithrombotic agents and 1.31% in those receiving a combination of aspirin and other drugs, reported Brian Hallstrom, MD, of University of Michigan Health System in Ann Arbor, and colleagues in JAMA Surgery.
- In comparison to patients receiving other chemoprophylaxis, the composite VTE outcome for aspirin alone was noninferior (adjusted OR 0.85; 95% CI 0.68-1.07, P=0.007 for inferiority).
- Prior findings were of low quality; the previous studies evaluated cases with asymptomatic deep venous thromboembolism, and underrepresented the risk of bleeding at the surgical site and the risk of reoperation following total knee arthroplasty (TKA), leading to concern surrounding publication bias in support of anticoagulant prophylaxis for VTE.
- Despite the rise in aspirin use for VTE prophylaxis following TKA over the last decade, "surgeons remain concerned about the safety and efficacy of this approach because of the limitations in studies supporting it," noted Robert Sterling, MD, and Elliot Haut, MD, PhD, both of Johns Hopkins University School of Medicine in Baltimore in an accompanying editorial.
- Clinicians still need to figure out whether or not patients have other risk factors, like obesity, active cancer, smoking, use of oral contraceptives, and previous history of blood clots, which might contribute to VTE after surgery, emphasized Bosco to MedPage Today.