Aspirin alone may be sufficient protection from postop VTE after total knee arthroplasty

Référence

Hood BR, Cowen ME, Zheng HT, Hughes RE, Singal B, Hallstrom BR. Association of aspirin with prevention of venous thromboembolism in patients after total knee arthroplasty compared with other anticoagulants. A noninferiority analysis. 2018 Oct 17. doi: 10.1001/jamasurg.2018.3858. [Epub ahead of print]

Sommaire

These investigators analyzed data from a retrospective cohort of 49,221 consecutive unilateral TKAs performed at a coalition of Michigan hospitals between April 2013 and October 2015. The exposure variable was treatment for VTE prophylaxis during the 3-day perioperative window, including aspirin alone, aspirin plus additional nonaspirin anticoagulation (eg, warfarin, direct-factor Xa inhibitors, low-molecular-weight heparin), nonaspirin anticoagulation only, or no pharmacoprophylaxis. The primary outcome was a composite of pulmonary embolism, deep venous thrombosis, or death during the 90-day postoperative period. The secondary outcome was the occurrence of a major bleeding event. Patients who received no prophylaxis had a significantly increased risk of a VTE event compared with those who received prophylaxis, but there were no significant differences in the rates of a VTE event in patients who took aspirin alone compared with other prophylactic regimens. Similarly, no significant differences in major bleeding events occurred in the aspirin-only versus other prophylactic regimens groups. During the study period the use of aspirin alone as the agent of choice for prophylaxis following TKA rose from 10.2% to 50.0% with no concurrent rise in the rate of VTE events or bleeding events.