Prevention of venous thromboembolism after total knee replacement by high-dose aspirin or intermittent calf and thigh compression.

Abstract

Summary and conclusions A prospective study of patients undergoing total knee replacement was carried out by using a combination of 15I-fibrinogen scanning and phlebography, and showed a high incidence of venous thromboembolic disease (TE). Ventilation-perfusion lung scanning was performed to detect pulmonary emboli in most patients. High doses of aspirin and an intermittent low-pressure pneumatic compression device (IPCD) were effective, even in women, in preventing TE. Low doses of aspirin and placebo were equally ineffective in preventing TE. Lung-scan abnormalities compatible with pulmonary emboli were found in six out of 10 patients with isolated calf-vein thrombi. Conventional tests of platelet function did not predict the development of TE. No significant differences were found between the patients receiving low and high doses of aspirin with respect to the mean template bleeding time or platelet aggregation in response to adenosine diphosphate, collagen, and epinephrine, although these variables were significantly abnormal in the two groups receiving aspirin compared with those treated with placebo and the IPCD.Thus high doses of aspirin and a new low-pressure IPCD were effective in preventing venous TE in patients (predominantly women) undergoing total knee replacement. IntroductionVenous thromboembolism (TE), a common complication of orthopaedic surgery,1-3 is also a major cause of postoperative death.4 Although effective prophylaxis with low-dose heparin is feasible in many patients, its efficacy in those undergoing orthopaedic surgery remains controversial5 6 and is compounded by bleeding complications.6 Controversy exists regarding the effectiveness of aspirin as a mode of prophylaxis in venous TE,7 particularly in women.' We conducted a pilot study, which showed a high incidence of TE (about 800o) in patients undergoing total knee replacement at our hospital.9 Patients with a mean intake of 3 5 g aspirin/day had a significantly lower incidence of TE than patients who had not ingested any aspirin. We report here a prospective study designed to evaluate the efficacy of a low dose of aspirin (325 mg thrice daily), a high dose of aspirin (13 g thrice daily), and an intermittent lowpressure pneumatic compression device (IPCD) as compared with placebo (one tablet thrice daily) in preventing TE in patients undergoing total knee replacement.

Deep vein thrombosis in spinal cord injury: effect of prophylaxis with calf compression, aspirin,and dipyridamole

“…Platelet affinity for collagen progressively increased in untreated patients, 78 per cent of whom subsequently developed DVT. Secondly, Salzman et al (1971) reported that the incidence of DVT in patients undergoing hip arthroplasty was reduced from 34 per cent to 9 per cent (p < 0'02) by aspirin prophylaxis, and similar results were reported in a study of subjects undergoing total knee replacement (McKenna et al, 1980). Thus, it appeared that the addition of aspirin might fu rther enhance the effectiveness of EPCC.…”

Prevention of VTE in Orthopedic Surgery Patients

“…In the 1970s and 1980s, a number of studies investigated the use of aspirin in THA, 10,[62][63][64][65] TKA, 66 and HFS. [67][68][69][70][71][72] Those studies used high doses of aspirin of up to 3.8 g daily.…”

“…900 patients undergoing arthroplasty or HFS compared mechanical compression to no thromboprophylaxis. 31,66,[76][77][78][79] Six used an IPCD, and one a venous foot pump (VFP). 77 The risk of bias varied.…”

Effect of NSAIDs on Na+/H+ exchanger activity in rat colonic crypts

“…Taken in high dosage, aspirin is also effective in the prevention of diabetic retinopathy (24) and is known to reduce the risk of venous thromboembolism in susceptible (i.e., postoperative) patients (22,40). Indomethacin, a highly potent NSAID (55), is prescribed for conditions such as rheumatoid arthritis (50), ocular inflammation (21), and primary headache disorders (49).…”