Pharmacologic Thromboprophylaxis Other Than Aspirin Is Associated With Increased Risk for Procedural Intervention for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction

Qin, Charles; Qin, Mia M.; Baker, Hayden P.; Shi, Lewis L.; Athiviraham, Aravind

doi:10.1016/j.arthro.2020.09.019

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…A retrospective insurance database study of 14,081 patients undergoing ACLR identified 191 patients who underwent either MUA or LOA for arthrofibrosis post-operatively 2154 . Only 499 patients (3.5%) received pharmacologic prophylaxis post-operatively.…”

Section: - Does the Development Of A Hematoma As A Results Of The Adm...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Section: - Does the Development Of A Hematoma As A Results Of The Adm...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…A 2022 study by Reynolds et al 21 reported reduced VTE incidence in patients undergoing knee arthroscopy when given aspirin (325 mg BID) or LMWH (40 mg QD) compared with historical rates of VTE. Interestingly, in 2021, Qin et al 20 reported that arthrofibrosis after anterior cruciate ligament repair occurred in 1.9% of patients who received aspirin, compared with 4.3% of patients who received chemoprophylaxis with agents other than aspirin, albeit their study did not comment on the effectiveness at preventing VTE.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Chemoprophylaxis in Knee Arthroscopy: A Break-Even Analysis of Cost

et al. 2022

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Background: Symptomatic venous thromboembolism (VTE) is a serious and costly complication after knee arthroscopy. There continues to be debate regarding the use of VTE prophylaxis after knee arthroscopy, and minimal research has explored its cost-effectiveness. Hypothesis: Both aspirin and enoxaparin would be cost-effective in preventing symptomatic VTE. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The literature was searched and the TriNetX research database was queried to determine a range of initial rates of VTE. An open-access retail database was used to determine the mean retail price for aspirin (325 mg) and enoxaparin (30 mg and 40 mg). Our institutional records were used to determine the cost of treating VTE. A “break-even” analysis was then performed to determine the absolute risk reduction necessary to make these drugs cost-effective. This value was then used to calculate the number of patients who would need to be treated (NNT) to prevent a single VTE while still breaking even on cost. Results: The cost of treating VTE was $9407 (US Dollars). Aspirin (325 mg), enoxaparin (30 mg), and enoxaparin (40 mg) were found to cost $1.86, $188.72, and $99.99, respectively. The low, TriNetX, and high rates of VTE were 0.34%, 0.86%, and 10.9%, respectively. Aspirin was cost-effective at all 3 rates if the initial rate decreased by 0.02% (NNT = 5058). Both formulations of enoxaparin were cost-effective at the high initial rate if they decreased by 2.01% (NNT = 50) and 1.06% (NNT = 94), respectively. However, at the low and TriNetX rates, the 2 doses of enoxaparin were not cost-effective because their final break-even rate exceeded the initial VTE rate. Conclusion: Aspirin and, in some cases, enoxaparin are cost-effective treatments for VTE prophylaxis after knee arthroscopy.

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“…A recent national insurance database study reported that only 3.5% of the more than 14,000 patients included in the study received pharmacologic thromboprophylaxis following ACL reconstruction. 12 Interestingly, pharmacologic thromboprophylaxis other than aspirin (acetylsalicylic acid) was associated with increased risk of procedural intervention for arthrofibrosis after ACL reconstruction. 12 In our study, DVT was associated with diabetes and obesity.…”

Section: Discussionmentioning

confidence: 99%

“… 12 Interestingly, pharmacologic thromboprophylaxis other than aspirin (acetylsalicylic acid) was associated with increased risk of procedural intervention for arthrofibrosis after ACL reconstruction. 12 In our study, DVT was associated with diabetes and obesity. Not using a tourniquet has also previously been reported to decrease the incidence of DVT after ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%