Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol

Abstract

Purpose Multimodal thromboprophylaxis includes preoperative thromboembolic risk stratification and autologous blood donation, surgery performed under regional anaesthesia, postoperative rapid mobilisation, use of pneumatic compression devices and chemoprophylaxis tailored to the patient's individual risk. We determined the 90-day rate of venous thromboembolism (VTE), other complications and mortality in patients who underwent primary elective hip and knee replacement surgery with multimodal thromboprophylaxis. Methods A total of 1,568 consecutive patients undergoing hip and knee replacement surgery received multimodal thromboprophylaxis: 1,115 received aspirin, 426 received Coumadin and 27 patients received low molecular weight heparin and Coumadin with or without a vena cava filter. Results The rate of VTE, pulmonary embolism, proximal deep vein thrombosis (DVT) and distal DVT was 1.2, 0.36, 0.45 and 0.36 %, respectively, in patients who received aspirin. The rates in those who received Coumadin were 1.4, 0.9, 0.47 and 0.47 %, respectively. There was no VTE detected in patients undergoing unicompartmental knee replacement. The overall 90-day mortality rate was 0.2 %. Conclusions Multimodal thromboprophylaxis in which aspirin is administered to low-risk patients is safe and effective following primary total joint replacement.

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

“…Vulcano et al [40] reported that aspirin is a safe and effective way of preventing postoperative VTE events in low-risk patients with TJA. Hamilton et al [19] found that inpatient enoxaparin followed by outpatient aspirin in patients with standard VTE risk was an effective means of thromboprophylaxis after TJA.…”

The natural history of a newly developed flexion contracture following primary total knee arthroplasty

“…All patients were weight bearing as tolerated and received multimodal thromboprophylaxis [15]. Pharmacological thromboprophylaxis for six weeks included aspirin in patients with a low risk of thromboembolic disease and Coumadin in those who were high risk [15]. Patients were discharged to home or an inpatient rehabilitation unit within three to six days after surgery.…”

“…Rehabilitation was initiated on the day of surgery with a continuous passive motion (CPM) machine set from 0 to 60°. All patients were weight bearing as tolerated and received multimodal thromboprophylaxis [15]. Pharmacological thromboprophylaxis for six weeks included aspirin in patients with a low risk of thromboembolic disease and Coumadin in those who were high risk [15].…”

Letter to the Editor: Not the Last Word: Safety Alert: One in 200 Knee Replacement Patients Die Within 90 Days of Surgery

“…Sing and colleagues [10] As a result of these temporal trends, contemporary studies of 90-day mortality following TKA report rates in the range 0.14% to 0.31% [2,5,7,12]. It appears, therefore, that a more accurate estimate of 90-day mortality is approximately 0.2% or one in 500.…”