Aspirin and Warfarin for Thromboembolic Disease After Total Joint Arthroplasty

Lotke, Paul A.; Palevsky, Harold I.; Keenan, Andrew M.; Meranze, Steven G.; Steinberg, Marvin E.; Ecker, Malcolm L.; Kelley, Mark A.

doi:10.1097/00003086-199603000-00031

Cited by 119 publications

(99 citation statements)

References 36 publications

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“…In this study, the rates of venographically detected thrombi with ASA (325 mg twice daily) and warfarin (prothrombin time 1AE2-1AE5 times normal) were similar (56AE6 vs. 53AE4%) (Lotke et al, 1996). Moreover, there were no differences in the rates of high-probability ventilation perfusion scans between the two treatments (ASA 9AE6 vs. 8AE2% warfarin).…”

Section: Evidence From Randomized Trialsmentioning

confidence: 50%

“…This was an open label trial with blinded outcome adjudication in 388 patients undergoing hip or knee replacement (Lotke et al, 1996). DVT was systematically sought by mandatory venography and PE was Lotke et al (1996), which used mandatory ventilation-perfusion scans. Background pneumatic compression device in all patients.…”

Section: Evidence From Randomized Trialsmentioning

confidence: 99%

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Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism?

et al. 2009

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SummaryGuidelines differ on whether acetyl salicylic acid (ASA, aspirin) should be used for prophylaxis in patients at high-risk of venous thromboembolism (VTE), principally because of differences in perceptions of its efficacy. ASA is an attractive therapeutic option because it is inexpensive, easy to administer and does not require monitoring. We critically reappraised the evidence from randomized controlled trials for the efficacy of ASA in VTE prevention. ASA is clearly efficacious in preventing VTE compared to placebo or no treatment, but appears to be less efficacious than the low molecular weight heparins in small trials. There is little data for ASA in comparison with unfractionated heparin and warfarin. A large randomized controlled trial is required to clarify the role of ASA compared to contemporary anticoagulant strategies for the prevention of VTE.

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Section: Evidence From Randomized Trialsmentioning

confidence: 50%

Section: Evidence From Randomized Trialsmentioning

confidence: 99%

Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism?

et al. 2009

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“…[23][24][25][26][27][28][29][30] Included Studies Table 1 presents the characteristics of the 8 included randomized trials. All were published in peer-reviewed journals from 1982 through 2006.…”

Section: Results Of Searchmentioning

confidence: 99%

“…All were published in peer-reviewed journals from 1982 through 2006. [23][24][25][26][27][28][29][30] The trials included a combined total of 1408 subjects, and took place in 4 different countries, including the United States, 24,26,[28][29][30] Spain, 23 Sweden, 27 and Canada. 25 Enrolled patients had a mean age of 76 years (range, 74-77 years) among hip fracture surgery studies and 66 years (range, 59-69 years) among elective knee/hip arthroplasty studies.…”

Section: Results Of Searchmentioning

confidence: 99%

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Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: A systematic review and meta-analysis

et al. 2014

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BACKGROUND Hip fracture surgery and lower extremity arthroplasty are associated with increased risk of both venous thromboembolism and bleeding. The best pharmacologic strategy for reducing these opposing risks is uncertain. PURPOSE To compare venous thromboembolism (VTE) and bleeding rates in adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery. DATA SOURCES Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library through June 2013; reference lists, ClinicalTrials.gov, and scientific meeting abstracts. STUDY SELECTION Randomized trials comparing aspirin to anticoagulants for prevention of VTE following major lower extremity orthopedic surgery. DATA EXTRACTION Two reviewers independently extracted data on rates of VTE, bleeding, and mortality. DATA SYNTHESIS Of 298 studies screened, 8 trials including 1408 participants met inclusion criteria; all trials screened participants for deep venous thrombosis (DVT). Overall rates of DVT did not differ statistically between aspirin and anticoagulants (relative risk [RR]: 1.15 [95% confidence interval {CI}: 0.68–1.96]). Subgrouped by type of surgery, there was a nonsignificant trend favoring anticoagulation following hip fracture repair but not knee or hip arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80–3.20], 2 trials; arthroplasty RR: 1.00 [95% CI: 0.49–2.05], 5 trials). The risk of bleeding was lower with aspirin than anticoagulants following hip fracture repair (RR: 0.32 [95% CI: 0.13–0.77], 2 trials), with a nonsignificant trend favoring aspirin after arthroplasty (RR: 0.63 [95% CI: 0.33–1.21], 5 trials). Rates of pulmonary embolism were too low to provide reliable estimates. CONCLUSION Compared with anticoagulation, aspirin may be associated with higher risk of DVT following hip fracture repair, although bleeding rates were substantially lower. Aspirin was similarly effective after lower extremity arthroplasty and may be associated with lower bleeding risk. Journal of Hospital Medicine 2014;9:579–585. © 2014 Society of Hospital Medicine

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Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement

et al. 2020

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IMPORTANCE Patients undergoing total hip replacement (THR) and total knee replacement (TKR) receive venous thromboembolism (VTE) pharmacoprophylaxis. It is unclear which anticoagulant is preferable. Observational data suggest aspirin provides effective VTE prophylaxis. OBJECTIVE To assess the effectiveness and safety of aspirin for VTE prophylaxis after THR and TKR. DATA SOURCES A systematic review and meta-analysis was performed of randomized clinical trials (RCTs), with no language restrictions, from inception to September 19, 2019, using MEDLINE, Embase, Web of Science, Cochrane Library, and bibliographic searches. The computer-based searches combined terms and combinations of keywords related to the population (eg, hip replacement, knee replacement, hip arthroplasty, and knee arthroplasty), drug intervention (eg, aspirin, heparin, clexane, dabigatran, rivaroxaban, and warfarin), and outcome (eg, venous thromboembolism, deep vein thrombosis, pulmonary embolism, and bleeding) in humans. STUDY SELECTION This study included RCTs assessing the effectiveness and safety of aspirin for VTE prophylaxis compared with other anticoagulants in adults undergoing THR and TKR. The RCTs with a placebo control group were excluded. The searches and study selection were independently performed. DATA EXTRACTION AND SYNTHESIS This study followed PRISMA recommendations and used the Cochrane Collaboration's risk of bias tool. Data were screened and extracted independently by both reviewers. Study-specific relative risks (RRs) were aggregated using random-effects models. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. MAIN OUTCOMES AND MEASURES The primary outcome was any postoperative VTE (asymptomatic or symptomatic). Secondary outcomes were adverse events associated with therapy, including bleeding. RESULTS Of 437 identified articles, 13 RCTs were included (6060 participants; 3466 [57.2%] women; mean age, 63.0 years). The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and pulmonary embolism (PE) (RR, 1.01; 95% CI, 0.68-1.48). The risk of adverse events, including major bleeding, wound hematoma, and wound infection, was not statistically significantly different in patients receiving aspirin vs other anticoagulants. When analyzing THRs and TKRs separately, there was no statistically significant difference in the risk of VTE, DVT, and PE between aspirin and other anticoagulants. Aspirin had a VTE risk not statistically significantly different from low-molecular-weight heparin (RR, 0.76; 95% CI, 0.37-1.56) or rivaroxaban (RR, 1.52; 95% CI, 0.56-4.12). The quality of the evidence ranged from low to high. CONCLUSIONS AND RELEVANCE In terms of clinical effectiveness and safety profile, aspirin did not differ statistically significantly from other anticoagulants used for VTE prophylaxis after THR and TKR. Futu...

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Aspirin and Warfarin for Thromboembolic Disease After Total Joint Arthroplasty

Cited by 119 publications

References 36 publications

Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism?

Does acetyl salicylic acid (ASA) have a role in the prevention of venous thromboembolism?

Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: A systematic review and meta-analysis

Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement

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