Key result
Use of low-molecular-weight heparins after total knee replacement was associated with a higher risk of venous thromboembolism compared with aspirin (HR 17.2; 95% CI 6.9-43.0).
Why the study?
Does the use of NOACs or LMWHs reduce VTE, GI bleeding, and mortality compared with aspirin in patients undergoing total knee and hip replacements?
Cohort (n=7,277)
Does the use of NOACs or LMWHs reduce VTE, GI bleeding, and mortality compared with aspirin in patients undergoing total knee and hip replacements?
In patients undergoing total joint replacement, LMWHs were associated with higher risks of VTE, GI bleeding, and mortality compared to aspirin, contrasting with previous studies.
LMWH associated with higher VTE, bleeding, and mortality than aspirin post-joint replacement; leaves open optimal prophylaxis pending RCTs.
BACKGROUND: There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery. OBJECTIVE: This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement. METHODS: A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink. Patients ≥18 years of age who had undergone total knee (n = 3261) or hip replacement (THR (n = 4016)) between 2008 and 2012 were included. Within this population, three cohorts were selected, based on their first prescription within the 35-day period after surgery: use of NOACs only, LMWHs only and aspirin only. Incidence rates were calculated, and Cox proportional hazard models were fitted to estimate the risk of VTE, GI bleeding and all-cause mortality with the use of NOACs and LMWHs compared with aspirin use after total knee replacement and THR. We statistically adjusted our analyses for lifestyle factors, comorbidities and concomitant drug use. RESULTS: Total knee replacement and THR patients currently on LMWHs had higher risk of VTE (HR = 17.2 (6.9-43.0) and HR = 39.5 (18.0-87.0), respectively), GI bleeding (HR = 20.9 (1.9-232.3) and HR = 2.0 (0.2-17.2), respectively) and all-cause mortality (HR = 4.3 (1.7-12.4) and HR = 4.0 (2.4-6.7), respectively). NOAC use was associated with an increased risk of GI bleeding in patients undergoing THR surgery. CONCLUSIONS: In contrast to previous studies, we found an increased risk of VTE, GI bleeding and all-cause mortality with the use of LMWHs compared with aspirin. Risk of GI bleeding was increased with the use of NOACs compared with aspirin use after THR surgery.
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Nielen et al. (2016) conducted a cohort in Total knee and hip replacements (n=7,277). Low-molecular-weight heparins (LMWHs) or new oral anticoagulants (NOACs) vs. Aspirin was evaluated on Venous thromboembolism (VTE) after total knee replacement (HR 17.2, 95% CI 6.9-43.0). Use of low-molecular-weight heparins after total knee replacement was associated with a higher risk of venous thromboembolism compared with aspirin (HR 17.2; 95% CI 6.9-43.0).
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