August 3, 2023Open Access

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

PICO estructurado

Does aspirin prevent symptomatic 90-day VTE in patients undergoing total joint arthroplasty compared to LMWH or DOACs?

Población

1,867 patients aged 18 or older undergoing primary, elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) for osteoarthritis at 19 participating high-volume arthroplasty centers in Australia. Mean age 67.2, 54% male.

Intervención

Aspirin alone (100 mg orally daily) for venous thromboembolism (VTE) prophylaxis (median duration 42 days).

Comparador

Low-molecular weight heparin (LMWH) alone (dalteparin 5000 IU subcutaneously daily or enoxaparin 40 mg subcutaneously daily), LMWH and aspirin, or direct oral anticoagulants (DOACs - rivaroxaban 10 mg orally once daily).

Resultado

Symptomatic 90-day venous thromboembolism (VTE), including pulmonary embolism and deep venous thrombosis.hard clinical

Aspirin may be a suitable agent for VTE prophylaxis following total joint arthroplasty, though the low observed VTE rates in observational data are likely confounded by selective use in lower-risk patients.

Resumen

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).

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