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Aspirin alone may be sufficient protection from postop VTE after total knee arthroplasty
Clinical Question
Is aspirin alone effective in preventing postoperative venous thromboembolism in adults after total knee arthroplasty?
Bottom line
This study found no significant differences in the risk of a venous thromboembolic (VTE) event or a major bleeding episode in adults given aspirin alone compared with other anticoagulation agents for prophylaxis following a total knee arthroplasty (TKA). This retrospective study may be biased because lower-risk patients were more likely to be given aspirin only. However, a recent randomized trial also reported similar efficacy for low-dose aspirin compared with rivaroxaban for the prevention of symptomatic VTE or major bleeding episodes following TKA. 2b-
Reference
Study design: Cohort (retrospective)
Funding: Self-funded or unfunded
Setting: Inpatient (any location) with outpatient follow-up
Synopsis
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.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC