Deep Vein Thrombosis Prevention in Joint Arthroplasties

Gelfer, Yael; Tavor, Hovav; Oron, Amir; Peer, Amir; Halperin, Nahum; Robinson, Dror

doi:10.1016/j.arth.2005.04.031

Cited by 70 publications

(34 citation statements)

References 22 publications

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“…Our incidence of VTE is low compared to that of Caucasian populations. In a review of the literature, there is only a single study on a Caucasian population which revealed similar a similar incidence of DVT -Gelfer et al showed an incidence of DVT of 6.6% in a THA and TKA population that was treated only by mechanical prophylaxis therapy coupled with aspirin [30]. An explanation for this difference between the Asian and Western populations is most likely due to the prevalence of prothrombotic factors in Caucasians which cause them to have a higher risk of developing VTEs as compared to Asians, regardless of the type of surgery performed [31].…”

Section: Discussionmentioning

confidence: 99%

Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism

et al. 2019

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Background Venous thromboembolism (VTE) of the lower limbs is an important complication post total knee arthroplasty (TKA). Current guidelines recommend routine chemical prophylaxis to all patients undergoing this procedure but this is rarely done in Asia as it is believed that Asians have a lower risk of VTE. However, recent evidence suggests otherwise. Aims We evaluated the incidence of DVT after TKA in a multi-ethnic Asian population with and without pharmacological prophylaxis, as well as the management and outcome of patients with post-operative DVTs. Methods We conducted a retrospective study of consecutive patients who underwent TKA in our hospital from 1st January 2004 to 30th December 2014. All patients were on mechanical thromboprophylaxis via calf pumps after TKA with a postoperative day 3 to 5 doppler ultrasound (DUS) of bilateral lower limbs. 2258 (80.7%) patients did not receive additional chemoprophylaxis, while 540 (19.3%) received chemoprophylaxis on top of mechanical thromboprophylaxis. All patients who received chemoprophylaxis were administered the drug until they were ambulating, with a median administration duration of 6 days. Patients were followed up for a period of 3 months for recurrence of DVTs and 24 months for postoperative outcome scores. Results Two thousand nine hundred seventy-eight patients had DUS of the lower limbs with 134 diagnosed with DVT giving an incidence of 4.5%. Six of these patients had concurrent PEs. There were 26 (19.4%) proximal DVTs and 108 (80.6%) distal DVTs. After 3 months of follow up, no additional VTE occurred. None of the DVTs or PEs progressed. All DVTs with accompanying PE were proximal. 102 out of 2200 patients (4.6%) without chemoprophylaxis developed DVT as compared to 32 out of 540 patients (5.9%) with chemoprophylaxis, which was not statistically significant ( p = 0.13). 19 (0.8%) proximal and 83 (3.8%) distal DVT developed in the patient group without chemoprophylaxis while 4 (0.7%) proximal and 28 (5.2%) distal DVT developed in the patient group with ( p = 0.62). Comparison of the incidence of PEs between the two groups, revealed a similar incidence with 5 out of 2200 patients (0.2%) without chemoprophylaxis developing PE as compared to 1 out of 540 patients (0.2%) with chemoprophylaxis ( p = 0.87). In addition, patients with chemoprophylaxis showed an association with higher post-operative outcome scores such as post op 6 months SF36 (PCS), post op 12 months SF36 (PCS), post op 12 months SF36 (MCS), post op 24 months SF36 (MCS) and post op 24 months WOMAC. Conclusion In one of the largest Asian studies specifically investigating the incidence of DVT after TKA, we found that the incidence is low at 4.5%. This is in contrast to recent studies that showed higher post-operative VTE rates similar to Western populati...

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Section: Discussionmentioning

confidence: 99%

Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism

et al. 2019

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“…Two were subsequently excluded. Thirteen RCTs 9,11,[17][18][19][20][21][22][23][24][25][26][27] (summarized in Table 1 and Table 2) met the meta-analysis inclusion criteria.…”

Section: Study Identificationmentioning

confidence: 99%

“…The mean age of participants was 63.0 years. Eleven trials [17][18][19][20][21][22][23][24][25][26][27] were open-label, and 2 trials 9,11 were double-blinded. Seven studies 9,11,18,[22][23][24][25] were from North America, 4 studies 17,19,21,26 were from Asia, and 2 studies 20,27 were from Europe.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seven studies 11,18,20,21,23,25,27 reported only on patients undergoing THR, 3 studies 9,17,22 reported on both patients undergoing THR and patients undergoing TKR, and 3 studies 19,24,26 reported only on patients undergoing TKR. The most common comparators were LMWH (5 studies 11,17,20,24,26 ) or rivaroxaban (3 studies, 9,19,26 one of which used an initial 5-day course of LMWH followed by 14 days of rivaroxaban 19 ). All studies 9,11,[17][18][19][20][21][22][23][24][25][26][27] reported VTE events.…”

Section: Study Characteristicsmentioning

confidence: 99%

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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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“…15 , 77 , 126 - 130 The PEP trial evaluated the efficacy of low dose aspirin (160 mg/day). 15 The relevant literature includes studies evaluating a wide range of doses of aspirin as VTE prophylaxis with doses of 75 mg, 13 81 mg, 92 100 mg, 17 , 51 , 98 , 131 150 mg, 41 , 47 , 99 160 mg, 15 , 132 162 mg, 9 , 42 , 43 250 mg, 133 300 mg, 130 325 mg, 95 600 mg, 24 650 mg, 9 , 27 , 42 , 43 1200 mg, 82 , 84 , 115 , 129 , 130 1300 mg, 31 , 33 , 35 , 93 , 134 , 135 and 3600 mg. 129 , 130 One unresolved issue in relation to the dose is the variation in the sensitivity to aspirin among patients. 136 There is no routine screening test that predicts this sensitivity.…”

Section: What Dose Of Aspirin Should Be Given To Patients Undergoing mentioning

confidence: 99%

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty

Azboy

Barrack

Thomas

et al. 2017

The Bone & Joint Journal

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The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences.Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a ‘milder’ agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents.The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use. There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE.Cite this article: Bone Joint J 2017;99-B:1420–30.

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Deep Vein Thrombosis Prevention in Joint Arthroplasties

Cited by 70 publications

References 22 publications

Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism

Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism

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

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty

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