Selection Bias, Orthopaedic Style

Pellegrini, Vincent D.; Eikelboom, John W.; Evarts, Charles M.; Franklin, Patricia D.; Goldhaber, Samuel Z.; Iorio, Richard; Lambourne, Carol A.; Magaziner, Jay; Magder, Laurence S.

doi:10.2106/jbjs.19.01135

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…Many studies support the use of aspirin for primary VTE prophylaxis, but much of the available evidence is considered low quality because it is retrospective and/or subject to selection bias. 18 On the other hand, there is a significant amount of high-quality evidence relevant to aspirin use in this postarthroplasty setting; we review this evidence here.…”

Section: Primary Prophylaxis Of Venous Thrombosismentioning

confidence: 99%

Does aspirin prevent venous thromboembolism?

Diep

García

2020

Hematology

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Venous thromboembolism (VTE; deep vein thrombosis and/or pulmonary embolism) is a well-established cause of morbidity and mortality in the medical and surgical patient populations. Clinical research in the prevention and treatment of VTE has been a dynamic field of study, with investigations into various treatment modalities ranging from mechanical prophylaxis to the direct oral anticoagulants. Aspirin has long been an inexpensive cornerstone of arterial vascular disease therapy, but its role in the primary or secondary prophylaxis of VTE has been debated. Risk-benefit tradeoffs between aspirin and anticoagulants have changed, in part due to advances in surgical technique and postoperative care, and in part due to the development of safe, easy-to-use oral anticoagulants. We review the proposed mechanisms in which aspirin may act on venous thrombosis, the evidence for aspirin use in the primary and secondary prophylaxis of VTE, and the risk of bleeding with aspirin as compared with anticoagulation.

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Section: Primary Prophylaxis Of Venous Thrombosismentioning

confidence: 99%

Does aspirin prevent venous thromboembolism?

Diep

García

2020

Hematology

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“…There are concerns that aspirin may not provide adequate prophylaxis in patients with a prior history of PE or DVT, hypercoagulable states, thrombophilia, active cancer, and obesity with limited mobilization. It is hoped that the results of the ongoing Pulmonary Embolism Prevention Hip and Knee Replacement trial (known as The PEPPER trial), which compares symptomatic VTE rates with aspirin, rivaroxaban, or adjusted-dose warfarin prophylaxis, will provide the answers 15 .…”

Section: Pharmacologic Methodsmentioning

confidence: 99%

Venous Thromboembolic Prophylaxis After Total Hip and Knee Arthroplasty

Lieberman

Bell

2021

Journal of Bone and Joint Surgery

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ä The selection of an agent for prophylaxis against venous thromboembolism (VTE) is a balance between efficacy and safety. The goal is to prevent symptomatic VTE while limiting the risk of bleeding.ä The optimal agent for VTE prophylaxis has not been identified. The American College of Chest Physicians guidelines recommend that, after total hip or total knee arthroplasty, patients receive at least 10 to 14 days of 1 of the following prophylaxis agents: aspirin, adjusted-dose vitamin K antagonist, apixaban, dabigatran, fondaparinux, low-molecular-weight heparin, low-dose unfractionated heparin, rivaroxaban, or portable home mechanical compression. Venous Thromboembolic Prophylaxis GuidelinesIn 2011, the American Academy of Orthopaedic Surgeons (AAOS) released their second guideline for VTE prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) 7 . The major focus of this guideline was the efficacy and Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G548).

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“…Ongoing trials in this population will help to further clarify whether aspirin should replace anticoagulant prophylaxis after total joint arthroplasty. 16,17 ARTICLE INFORMATION…”

Section: Editorialmentioning

confidence: 99%