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Surgeon: Aspirin may be all the PE prophylaxis most total joint replacement patients need

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SAN FRANCISCO — Clinical investigators continue to debate the most effective way to prevent patients undergoing total joint replacement from developing a pulmonary embolism; however, such prevention may simply be a matter of using aspirin, according to one researcher.

The American Academy of Orthopaedic Surgeons issued its own guidelines for preventing pulmonary embolism (PE) in individuals undergoing total joint replacement surgery. The academy's clinical guidelines support using aspirin as an alternative chemoprophylactic agent, said Paul A. Lotke, MD, of Philadelphia.

Lotke discussed the use of aspirin for preventing PE at a meeting of the Knee Society, held here during the American Association of Hip and Knee Surgeons Specialty Day Meeting.

He explained that orthopedists who opt to use aspirin for PE prophylaxis should expect some difficulty convincing the internists they work with to go that route. To prepare his colleagues for such an encounter, he provided them with arguments to support their stance if they decide a patient is a candidate for aspirin as PE prophylaxis.

"We should tell internists that the risks from major [bleeding] or less-than-major bleeding have not been assessed," Lotke said.

He also explained that many studies conducted by pharmaceutical companies compared one drug to another, but did not focus on outcomes such as bleeding. "They are not designed to study clinical outcomes," he said.

Lotke pointed out that bleeding — one of the major risks of some chemical interventions — can range from 2% to 5% with heparin.

According to Lotke, total joint replacement patients at risk for increased bleeding should simply be managed more aggressively. Orthopedists should also make internists aware that when patients are mobilized earlier, fatal PE risks can drop substantially to 0.1% regardless of the agent used.

For more information:

• Lotke PA. What you can tell your internist about why aspirin is enough. Symposium II: PE prophylaxis: Is there still a controversy? Presented at the Knee Society/American Association of Hip and Knee Surgeons Specialty Day Meeting. March 8, 2008. San Francisco.