In patients undergoing elective total hip arthroplasty, thromboprophylaxis with LMWH was associated with a higher 90-day mortality rate (1.09%) compared to aspirin (0.43%) (p < 0.05).
Cohort (n=7,983)
Does LMWH or warfarin reduce fatal pulmonary embolism or all-cause mortality compared to aspirin in patients undergoing elective primary total hip arthroplasty?
Aspirin is an appropriate and potentially safer thromboprophylaxis agent compared to LMWH in patients undergoing elective total hip arthroplasty, as LMWH was associated with higher all-cause mortality without added benefit for fatal PE prevention.
Absolute Event Rate: 1.09% vs 0.43%
p-value: p=<0.05
AIMS: The place of thromboprophylaxis in arthroplasty surgery remains controversial, with a challenging requirement to balance prevention of potentially fatal venous thrombo-embolism with minimising wound-related complications leading to deep infection. We compared the incidence of fatal pulmonary embolism in patients undergoing elective primary total hip arthroplasty (THA) between those receiving aspirin, warfarin and low molecular weight heparin (LMWH) for the chemical component of a multi-modal thromboprophylaxis regime. PATIENTS AND METHODS: A prospective audit database was used to identify patients who had died within 42 and 90 days of surgery respectively between April 2000 and December 2012. A case note review was performed to ascertain the causes of death. RESULTS: During this period 7983 THAs were performed. The rate of mortality was 0.43% and 0.58% at 42 and 90 days respectively. The groups comprised 1571 patients (19.7%) on warfarin, 1838 (23.0%) on LMWH and 4574 (57.3%) on aspirin. The 90-day mortality for these three groups was 0.38%, 1.09% and 0.43% respectively. The higher mortality rate for LMWH was significant (p < 0.05). There were six fatal pulmonary emboli (PEs) (0.08%). A total of three occurred within 42 days, all in the LMWH group. A total of three occurred between 42 and 90 days; one on warfarin, two on LMWH. The leading causes of death in all three groups were lower respiratory tract infections and myocardial infarction. CONCLUSION: We confirmed that fatal PE following elective THA with a multi-modal prophylaxis regime is rare. We further found that LMWH conferred no benefit over aspirin in this context, and is associated with a higher all-cause rate of mortality. TAKE HOME MESSAGE: This study proposes that aspirin may be an appropriate thromboprophylaxis agent when used as part of a multi-modal regimen, suggesting current guidelines should be reviewed. Cite this article: Bone Joint J 2016;98-B:585-8.
Bayley et al. (2016) conducted a cohort in Elective primary total hip arthroplasty (THA) (n=7,983). Low molecular weight heparin (LMWH) vs. Aspirin and Warfarin was evaluated on 90-day mortality (p=<0.05). In patients undergoing elective total hip arthroplasty, thromboprophylaxis with LMWH was associated with a higher 90-day mortality rate (1.09%) compared to aspirin (0.43%) (p < 0.05).