This article is more than 5 years old. Information may no longer be current.
Low-dose aspirin may prevent PE, DVT events in patients after TKA
Research into the effect of even lower aspirin doses on venous thromboembolism would be helpful.
Click Here to Manage Email Alerts
Low-dose aspirin used for the prevention of venous thromboembolism following total knee arthroplasty showed similar effects to those seen with high-dose aspirin, according to results published in The Journal of Arthroplasty.
Compared to high-dose aspirin in the setting of TKA, “We found out low-dose aspirin showed similar prophylactic effect in terms of venous thromboembolism — both pulmonary embolism [PE] and deep venous thrombosis — and they appeared to have similar complication profiles in terms of bleeding, whether it was wound bleeding or gastrointestinal bleeding, as well as mortality within 90 days after surgery,” Mhamad Faour, MD, clinical research fellow at Cleveland Clinic Foundation, told Orthopedics Today.
Faour and his colleagues collected postoperative information about complications, including VTE, bleeding and mortality, for 5,666 patients who received either 81-mg (n=1,327, low-dose group) or 325-mg (n=4,339, high-dose group) aspirin twice daily for 4 to 6 weeks after TKA.
The researchers found the VTE incidence was 0.5% for patients who received 325-mg aspirin and 0.7% for patients who received 81-mg aspirin. They noted the incidence of symptomatic DVT was 1.4% and 0.3% in the high-dose and low-dose groups, respectively.
Aspirin dose had no correlation with VTE or DVT incidence, according to a regression model. The high-dose aspirin group had a PE incidence of 0.2% vs. 0.4% in the low-dose aspirin group. In the findings, both groups showed similar complications of bleeding (0.2%) and mortality (0.1%).
According to Faour, low-dose aspirin can be considered a safe and effective agent in the prevention of VTE after TKA in low-risk patients. Although aspirin has been proven to prevent VTE, it is still associated with a risk of bleeding. Researchers should review whether an even lower dose of aspirin than was studied, such as 81 mg once daily, which is the dose recommended to prevent cardiovascular events, may be as effective for the prevention of VTE with lower risk of side effects. – by Casey Tingle
- Reference:
- Faour M, et al. J Arthroplasty. 2018;doi:10.1016/j.arth.2018.03.001.
- For more information:
- Mhamad Faour, MD, can be reached at 9500 Euclid Ave., A-41, Cleveland, OH 44195; email: homrocj2@ccf.org.
Disclosure: Faour reports no relevant financial disclosures.
Perspective
Back to Top
Jay R. Lieberman, MD
Aspirin has been found to provide effective and safe prophylaxis after TKA. However, the ideal dose and duration of aspirin prophylaxis has not been determined. Faour and colleagues performed a retrospective review of TKA patients to assess the efficacy of low and high doses of aspirin in preventing symptomatic VTE and bleeding in patients after TKA. The authors found low-dose aspirin was not inferior to high-dose aspirin and bleeding rates were the same in both groups (0.2%). The strengths of this study were that it included 5,666 patients and there was a meticulous review of the medical records. The major weakness is this was a retrospective review, so it is not possible to determine how patients were selected to receive low-dose or high-dose aspirin or another anticoagulant regimen, so there may be unintended bias. In addition, the authors were unable to determine superiority of the low-dose or high-dose regimen based on the number of patients in the study. Recently, Parvizi and colleagues published a prospective, crossover study analyzing 4,651 patients who underwent total joint arthroplasty and they concluded low-dose aspirin was non-inferior to high-dose aspirin for VTE after TJA.
The selection of a prophylaxis regimen after TKA is a balance between efficacy and safety. Aspirin provides effective prophylaxis, but it remains unknown whether a low dose is as effective as, but also safer than a high dose. In addition, it is essential to remember aspirin may not provide sufficient prophylaxis for some high-risk patients including those with a prior history of DVT or PE, hypercoagulable states, obesity and those who are slow to mobilize.
Reference:
Parvizi J, et al. J Bone Joint Surg Am. 2017;doi:10.2106/JBJS.16.00147
Read more about
Click Here to Manage Email Alerts