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Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The most effective agent for prophylaxis against venous thromboembolic disease after total joint arthroplasty (TJA) remains unknown. The paucity of literature comparing different methods of pulmonary embolism (PE) prophylaxis and fear of litigation make it difficult for surgeons to abandon the use of aggressive chemical prophylaxis.

Questions/purposes

We compared the (1) overall frequency of symptomatic PE, (2) risk of symptomatic PE after propensity matching that adjusted for potentially confounding variables, and (3) other complications and length of stay before and after propensity matching in patients undergoing TJA at our institution who received either aspirin or warfarin prophylaxis.

Methods

A total of 28,923 patients underwent TJA between January 2000 and June 2012 at our institution, had either aspirin (325 mg twice daily; 2800 patients) or warfarin prophylaxis (26,123 patients), and were registered in our institutional electronic database. The incidence of symptomatic PE, symptomatic deep vein thrombosis (DVT), hematoma formation, infection, wound complications, and mortality up to 90 days postoperatively was collected from the database. We performed multivariate analysis and 3:1 and 5:1 propensity score matching for comorbid and demographic variables.

Results

The overall symptomatic PE rate was lower (p < 0.001) in patients receiving aspirin (0.14%) than in the patients receiving warfarin (1.07%). This difference did not change after matching. The aspirin group also had significantly fewer symptomatic DVTs and wound-related problems and shorter hospital stays, which did not change after matching.

Conclusions

After publication of the American Academy of Orthopaedic Surgeons’ guidelines, some surgeons have utilized aspirin as thromboprophylaxis after TJA. Based on our findings from a large institutional database, aspirin offers suitable prophylaxis against symptomatic PE in selected patients.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

The authors thank our statistician Mitchell G. Maltenfort PhD for his contribution in the statistical analyses conducted in this study. We also acknowledge the efforts of Camilo Restrepo MD in managing our database and assisting in the editing of this paper.

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Authors and Affiliations

  1. Orthopaedic Research at the Rothman Institute, Thomas Jefferson Hospital, Philadelphia, PA, USA

    Ibrahim J. Raphael MD & Eric H. Tischler BA

  2. Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Ronald Huang MD, Richard H. Rothman MD, PhD, William J. Hozack MD & Javad Parvizi MD, FRCS

Authors
  1. Ibrahim J. Raphael MD
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  2. Eric H. Tischler BA
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  3. Ronald Huang MD
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  4. Richard H. Rothman MD, PhD
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  5. William J. Hozack MD
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  6. Javad Parvizi MD, FRCS
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Raphael, I.J., Tischler, E.H., Huang, R. et al. Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?. Clin Orthop Relat Res 472, 482–488 (2014). https://doi.org/10.1007/s11999-013-3135-z

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  • DOI: https://doi.org/10.1007/s11999-013-3135-z

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