Key result
Aspirin matches LMWH for post-TKA VTE prophylaxis in obese patients.
Why the study?
Patients undergoing total knee arthroplasty are at high risk of thromboembolic events, which is higher in obese patients, making the determination of appropriate venous thromboembolism prophylaxis challenging.
Does aspirin or a combination of aspirin and low molecular weight heparin prevent venous thromboembolism as effectively as low molecular weight heparin alone in obese patients undergoing total knee arthroplasty?
Cohort (n=245)
No
Does aspirin or a combination of aspirin and low molecular weight heparin prevent venous thromboembolism as effectively as low molecular weight heparin alone in obese patients undergoing total knee arthroplasty?
p-value: p=>0.05
Aspirin is not inferior to enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty in obese patients, offering a safe and cost-effective alternative.
Aspirin was associated with similar VTE rates post-TKA in obese patients; leaves open confirmation of noninferiority in randomized trials.
Purpose Patients undergoing total knee arthroplasty (TKA) are at a high risk of thromboembolic events, which is higher in obese patients. Determining the appropriate prophylaxis for venous thromboembolism (VTE) in obese patients is challenging. Therefore, we aimed to compare the effects of low molecular weight heparin (LMWH) with aspirin (ASA) and their combination for the prevention of thromboembolic events after TKA in obese patients. Methods In a retrospective study, 245 obese patients with BMIs over 30 who underwent TKA were enroled. Eligible patients were divided into three groups: Group A was given LMWH sodium (Clexane®) for 14 days, Group B was given ASA for 14 days, and Group C was given LMWH sodium (Clexane®) for 5 days and then ASA twice daily for the days between 5 and 14 postoperatively. The primary outcome was the incidence of VTE within three months. Secondary outcomes included routine laboratory evaluations (PT, PTT, INR, Hb, Hct, platelets, BUN and Cr) and adverse effects of ASA and LMWH, such as bleeding, anaemia, thrombocytopenia, and gastrointestinal or neurological symptoms. Results Regarding the incidence of DVT and PTE, we did not observe significant differences between groups ( p > 0.05). A total of seven symptomatic VTE was observed in six patients. We observed two cases with PE who were in the Clexane group. Moreover, five individuals had DVT in the follow‐up: three cases in the Clexane group, one in the ASA group, and one in the ASA + Clexane group, which was not statistically significant ( p > 0.05). There were no differences between groups regarding the risk of adverse events and complications. Conclusion We found that ASA is not inferior to enoxaparin in reducing VTE after TKA in obese patients. Therefore, given ASA's low cost and greater convenience, it may be considered a reasonable alternative for extended VTE prophylaxis for TKA surgery in obese patients. Level of Evidence Level III.
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Mirahmadi et al. (2025) conducted a cohort in Obesity and knee osteoarthritis requiring total knee arthroplasty (n=245). Aspirin (ASA) vs. Low molecular weight heparin (LMWH) or ASA + LMWH was evaluated on Incidence of venous thromboembolism (VTE) within three months (p=>0.05). Aspirin was not inferior to low molecular weight heparin or their combination for venous thromboembolism prophylaxis after total knee arthroplasty in obese patients, with no significant difference in VTE incidence between groups (p > 0.05).
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