Low-Dose Aspirin Is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Hip Arthroplasty: A Retrospective Cohort Study

Tang, Alex; Zak, Stephen; Iorio, Richard; Slover, James; Bosco, Joseph; Schwarzkopf, Ran

doi:10.1016/j.arth.2020.03.040

Cited by 18 publications

(11 citation statements)

References 36 publications

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“…The subjects of this study are elderly patients 50 years and older. The elasticity of blood vessels are poor and elder patients are complicated by the physiological or organic changes of multiple organs, and the perioperative period of lower extremity joint mobility and the amount of activity are significantly reduced, so the risk of DVT is higher[ 24 – 26 ]. We have found that age > 70y, BMI ≥ 28, diabetes, bilateral joint replacements, duration of surgery ≥ 120 min, cemented prosthesis, and duration of days in bed > 3 days were the independent risk factors of DVT of lower limb in patients with THA.…”

Section: Discussionmentioning

confidence: 99%

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

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2021

BMC Musculoskelet Disord

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Background Deep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty(THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA. Methods Patients who underwent THA in our hospital from January 1, 2017 to November 30, 2020 were included. The personal characteristics and clinical data of DVT and no-DVT patients were compared and analyzed. Logistic regression analyses were perfomed to identify the potential risk factors of DVT in patients with THA. Results A total of 182 THA patients were included, the incidence of DVT of lower limb in patients with THA was 19.78 %. There were significant differences in the age, BMI, diabetes, number of replacement, duration of surgery, type of prosthesis and duration of days in bed between DVT and no-DVT patients(all P < 0.05). And there were no significant differences in the gender, hypertension, hyperlipidemia, preoperative D-dimer, type of anesthesia and anticoagulant drugs use(all P > 0.05). Logistic regression analysis indicated that age > 70y(OR4.406, 95 %CI1.744 ~ 6.134), BMI ≥ 28(OR2.275, 95 %CI1.181 ~ 4.531), diabetes(OR3.949, 95 %CI1.284 ~ 5.279), bilateral joint replacements(OR2.272, 95 %CI1.402 ~ 4.423), duration of surgery ≥ 120 min(OR3.081, 95 %CI1.293 ~ 5.308), cemented prosthesis(OR2.435, 95 %CI1.104 ~ 4.315), and duration of days in bed > 3 days(OR1.566, 95 %CI1.182 ~ 1.994) were the risk factors of DVT of lower limb in patients with THA. Conclusions DVT in the lower limb after THA is common, and its onset is affected by many factors. In clinical work, attention should be paid to identify the risk factors for DVT and targeted interventions are highlighted to prevent the postoperative DVT.

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Section: Discussionmentioning

confidence: 99%

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

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2021

BMC Musculoskelet Disord

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“…Three retrospective studies within the past two years have cited low-dose ASA as a suitable chemoprophylactic agent in revision arthroplasty 391-393 . Tang et al, compared a prophylaxis protocol of 81 mg of ASA twice a day ( bis in die [bid]) compared to 325 mg ASA bid in 1,361 revision THA patients and found no difference in total VTE, bleeding, or any other complication between the two groups 391 . A similar retrospective study was conducted for patients undergoing revision TKA and also observed no significant difference between low- and high-dose ASA for total VTE, bleeding, or any other complications 392 .…”

Section: - Should the Methods For Vte Prophylaxis Be Altered In Patie...mentioning

confidence: 99%

“…There has also been a trend towards using a lower dose ASA for VTE prophylaxis in revision arthroplasty compared to the traditional higher doses used in earlier regimens. Three retrospective studies within the past two years have cited low-dose ASA as a suitable chemoprophylactic agent in revision arthroplasty 391-393 . Tang et al, compared a prophylaxis protocol of 81 mg of ASA twice a day ( bis in die [bid]) compared to 325 mg ASA bid in 1,361 revision THA patients and found no difference in total VTE, bleeding, or any other complication between the two groups 391 .…”

Section: - Should the Methods For Vte Prophylaxis Be Altered In Patie...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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“…[20][21][22]27 Other studies have shown the efficacy of low-dose (81 mg) ASA alone for VTE prophylaxis. [10][11][12][13][14][15]18 However, few studies have investigated if a regimen including outpatient use of mobile IPCDs with ASA provides more effective prophylaxis than ASA alone. Currently, only one randomized control trial (RCT) study has been published that found superior reduction in VTE incidence in standard-risk patients undergoing total knee arthroplasty (TKA) on 325-mg ASA BID who were discharged with outpatient portable IPCDs compared with patients with inpatient only IPCDs.…”

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confidence: 99%

“…1,2,9 While there is no optimal chemoprophylaxis regimen established, low-dose oral aspirin administered twice daily (81-mg ASA BID) has been shown to be a safe and low-cost option with similar efficacy to other anticoagulation medications such as 325-mg ASA BID, low molecular weight heparin (LMWH), warfarin, and factor X a inhibitors. [10][11][12][13][14][15] Selecting a safe pharmacologic agent becomes especially important when considering postoperative complications associated with these medications which include gastrointestinal (GI) bleeding, wound complications, superficial and deep infection, and mortality. [16][17][18] Mechanical prophylaxis alone has been shown to reduce VTE rates, with a lower rate of bleeding complications after THA when compared with anticoagulation therapy alone.…”

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confidence: 99%

Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

Tang

Lygrisse

Zak

et al. 2021

The Journal of Hip Surgery

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Venous thromboembolism (VTE) remains a serious complication following total hip arthroplasty (THA). Current guidelines recommend pharmacologic prophylaxis with or without intermittent pneumatic compression devices (IPCDs). At our institution, portable IPCDs were previously worn by THA patients at standard risk for VTE for 14 days. Routine prescription of portable outpatient IPCDs was discontinued due to concerns with their efficacy and safety. We sought to determine if discontinuation of portable outpatient IPCDs changed VTE rates after THA. A retrospective review of 1,825 consecutive THA cases was conducted identifying patients with VTE, periprosthetic fractures, dislocations, bleeding complications, infection, and death at 90 days postoperatively. Patients were divided into two cohorts. One cohort received outpatient IPCDs for a period of 14 days (control) while the other did not (no-IPCD). All patients received inpatient IPCDs and were maintained on 81-mg aspirin (ASA) twice daily for 28 days. A total of 748 IPCD patients and 1,077 no-IPCD patients were identified. There was no difference between the total VTE rate for the IPCD versus no-IPCD groups (0 vs. 0.19%, p = 0.24). There were also no differences in periprosthetic fractures (p = 0.09), dislocations (p = 0.22), bleeding complications (p = 0.79), or infection rates (p = 0.75). No deaths were observed. The use of a low-dose ASA thromboprophylaxis protocol was safe and effective for VTE prevention in standard-risk patients undergoing THA with or without portable IPCDs. Any marginal benefit of portable IPCD use was too small to demonstrate despite our relatively large sample size.

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Low-Dose Aspirin Is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Hip Arthroplasty: A Retrospective Cohort Study

Cited by 18 publications

References 36 publications

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Recommendations from the ICM-VTE: Hip & Knee

Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

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