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No difference seen between aspirin, low-molecular-weight heparin as VTE prophylaxis after orthopedic trauma
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ORLANDO, Fla. — No difference was seen in bleeding complications among patients who received aspirin compared with low-molecular-weight heparin as venous thromboembolism prophylaxis after orthopedic trauma with the exception of patients who had concomitant abdominal injury.
Bryce Haac, MD, presented the findings at the Orthopaedic Trauma Association Annual Meeting.
“[We] found higher-than-expected rates of union events in this population, with no overall difference in bleeding complications between aspirin and low-molecular heparin regimen,” Haac said during his presentation. “We did see increased transfusions in patients with abdominal injuries following the aspirin regimen. However, ... there were few patients with abdominal injuries and this will need further examination as it is statistically sensitive.”
Haac and colleagues performed a randomized controlled trial and assigned 329 patients with operative extremity, pelvic or acetabular fracture and required venous thromboembolism prophylaxis to either low-molecular-weight heparin 30 mg twice a day or to 81 mg of aspirin twice a day. Patients were followed for 90 days. A composite end point of bleeding events, such as reoperation/procedure for bleeding, gastrointestinal bleeding, blood transfusion or hemoglobin drop of less than 2 g/dL in 24 hours, was the primary outcome. Other outcomes included deep surgical site infection, pulmonary embolism and deep vein thrombosis. Investigators tested concomitant abdominal, head and chest injury as possible modifiers.
Results showed 32% of patients had a bleeding event; however, no difference was seen between the treatment groups. Investigators noted all bleeding events occurred within 18 days of injury. There were eight patients with deep surgical site infections, eight patients had a PE and 14 patients had a DVT. Bleeding complications were more likely to occur in patients who were allocated to aspirin treatment and had an abdominal injury. – by Monica Jaramillo
Reference:
Haac B, et al. Paper 66. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 18-20, 2018; Orlando, Fla.
Disclosure: Haac reports no relevant financial disclosures.