January 16, 2019Clinical Orthopaedics and Related ResearchOpen Access

No Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA

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Why the study?

Aspirin is established for VTE prophylaxis after THA, but there is no consensus on whether low- or regular-dose aspirin is more effective.

Does low-dose aspirin prevent symptomatic VTE as effectively as standard-dose aspirin in low-risk patients undergoing elective THA?

Population

3936 patients receiving aspirin alone for VTE prophylaxis after THA

Comparison

Low-dose aspirin (81 mg BID) vs standard-dose aspirin (325 mg BID)

Design

Retrospective cohort study

Follow-up

90 days

Authors

MFMhamad FaourCleveland Clinic Florida NPNicolás S. PiuzziCleveland Clinic DBDavid P. BrigatiThe University of Texas at Austin

Discussion

Member takes

Implication

May support low-dose aspirin for VTE prophylaxis after elective THA; hypothesis-generating and requires randomized confirmation.

Structured PICO

Does low-dose aspirin prevent symptomatic VTE as effectively as standard-dose aspirin in low-risk patients undergoing elective THA?

Population

3,936 low-risk patients (no history of VTE, recent orthopaedic surgery, hypercoagulable state, history of cardiac arrhythmia requiring anticoagulation, or receiving anticoagulation for any other medical conditions before surgery) who underwent elective total hip arthroplasty (THA) and received aspirin alone for VTE prophylaxis.

Intervention

Aspirin 81 mg oral twice daily for 4 to 6 weeks after surgery, initiated on the evening of or the next day after the procedure, plus multimodal VTE prophylaxis using pneumatic compression stockings and physical therapy.

Comparator

Aspirin 325 mg oral twice daily for 4 to 6 weeks after surgery, initiated on the evening of or the next day after the procedure, plus multimodal VTE prophylaxis using pneumatic compression stockings and physical therapy.

Outcome

Symptomatic VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]) within 90 days of surgery.hard clinical

In low-risk patients undergoing elective THA, low-dose aspirin (81 mg twice daily) is as effective as standard-dose aspirin (325 mg twice daily) for VTE prophylaxis, with no significant difference in bleeding or mortality.

Limitations

Selection bias (patients with fewer comorbidities received lower dose)
Transfer bias (completeness of follow-up)
Assessment bias (outcomes identified through chart review, possible outside diagnoses missed)
Underpowered to detect differences in secondary endpoints (PE, mortality, bleeding)
Retrospective design

Cite This Study

Faour et al. (2019) studied this question.

synapsesocial.com/papers/6a814b2a9fceb4fbd5e3e41f https://doi.org/10.1097/corr.0000000000000613

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No Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

No Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider