June 11, 2018
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Study: Unfractionated heparin should not be used with aspirin following THA, TKA as VTE prophylaxis

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Investigators of a study published in Orthopedics said unfractionated heparin should not be used as an additional mode of venous thromboembolism prophylaxis when aspirin is prescribed in patients who underwent total hip arthroplasty or total knee arthroplasty.

Perspective from Andreas F. Mavrogenis, MD

Ali H. Sobh

“Postoperative unfractionated heparin in addition to aspirin for venous thromboembolism prophylaxis is not superior to aspirin monotherapy,” Ali H. Sobh, MD, told Healio.com/Orthopedics. “[Unfractionated heparin] UH and [aspirin] ASA combination therapy is associated with increased rates of perioperative blood loss and postoperative allogeneic blood transfusion."

Sobh and colleagues performed a retrospective review and identified 5,350 patients who underwent either total hip arthroplasty or total knee arthroplasty. Based on VTE chemoprophylaxis, 1,024 patients received aspirin only; 1,695 patients received aspirin and one dose of unfractionated heparin; and 2,621 patients received aspirin and multiple doses of unfractionated heparin. Patient age, sex, BMI, American Society of Anesthesiologists score, smoking status, joint, OR time, history of deep venous thrombosis and preoperative hemoglobin were other independent variables included in the model.

Results showed the treatment groups were not significantly different with regard to DVT rates and pulmonary embolus rates. Compared with patients who received aspirin only, patients who received one dose of unfractionated heparin and multiple doses of unfractionated heparin had significantly greater transfusion rates. Investigators noted the use of unfractionated heparin significantly decreased postoperative hemoglobin. Compared to aspirin monotherapy, aspirin and unfractionated heparin combination therapy did not decrease the incidence of VTE. Patients who received unfractionated heparin had a greater perioperative blood loss and had an increased rate of blood transfusions. – by Monica Jaramillo

 

Disclosures : The authors report no relevant financial disclosures.