Comparative effectiveness of aspirin for symptomatic venous thromboembolism prophylaxis in patients undergoing total joint arthroplasty, a cohort study

• Published in: BMC musculoskeletal disorders Vol. 24; no. 1; p. 629
• Main Authors: Sidhu, Verinder, Badge, Helen, Churches, Timothy, Maree Naylor, Justine, Adie, Sam, A Harris, Ian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.08.2023; BioMed Central; BMC
• Subjects: Anesthesia; Anticoagulants; Arthritis; Arthroplasty; Arthroplasty (hip); Arthroplasty (knee); Aspirin; Cohort analysis; Complications; Compression therapy; Disease prevention; Heparin; Informed consent; Joint surgery; Low-molecular Weight Heparin; Missing data; Molecular weight; Novel oral anticoagulants; Osteoarthritis; Patient outcomes; Patients; Prevention; Prophylaxis; Pulmonary embolisms; Regression analysis; Risk factors; Statistics; Surgeons; Surgery; Thromboembolism; Thrombosis; Variables; Venous thromboembolism; Venous thrombosis; Australia; Aspirin; Arthroplasty; Novel oral anticoagulants; Low-molecular Weight Heparin; Venous thromboembolism
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06750-x

This study compares the symptomatic 90-day venous thromboembolism (VTE) rates in patients receiving aspirin to patients receiving low-molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs), after total hip (THA) and total knee arthroplasty (TKA). Data were collected from a multi-centre cohort study, including demographics, confounders and prophylaxis type (aspirin alone, LMWH alone, aspirin and LMWH, and DOACs). The primary outcome was symptomatic 90-day VTE. Secondary outcomes were major bleeding, joint related reoperation and mortality within 90 days. Data were analysed using logistic regression, the Student's t and Fisher's exact tests (unadjusted) and multivariable regression (adjusted). There were 1867 eligible patients; 365 (20%) received aspirin alone, 762 (41%) LMWH alone, 482 (26%) LMWH and aspirin and 170 (9%) DOAC. The 90-day VTE rate was 2.7%; lowest in the aspirin group (1.6%), compared to 3.6% for LMWH, 2.3% for LMWH and aspirin and 2.4% for DOACs. After adjusted analysis, predictors of VTE were prophylaxis duration < 14 days (OR = 6.7, 95% CI 3.5-13.1, p < 0.001) and history of previous VTE (OR = 2.4, 95% CI 1.1-5.8, p = 0.05). There were no significant differences in the primary or secondary outcomes between prophylaxis groups. Aspirin may be suitable for VTE prophylaxis following THA and TKA. The comparatively low unadjusted 90-day VTE rate in the aspirin group may have been due to selective use in lower-risk patients. This study was registered at ClinicalTrials.gov, trial number NCT01899443 (15/07/2013).