Revision TJA alone not linked with higher VTE, wound drainage rates
Click Here to Manage Email Alerts
There was no difference in venous thromboembolism and wound drainage rates in a comparison of chemoprophylactic agents used in low-risk patients who underwent revision compared with primary total joint arthroplasty, according to study results.
“A major take home message from our study is in relation to cost effectiveness. If we look at out of pocket cost for the medications in this study, Aspirin costs approximately $0.13 per dose,” Gregory Manista, MD, told Healio.com/Orthopedics. “This is compared to the more aggressive prophylaxis which can go for $18 per dose and as high as $ 37per dose for Rivaroxaban and Enoxaparin, respectively. With this taken into consideration, there is a major implication for healthcare cost reduction and savings, especially in healthier patients with associated lower risk factors. A less aggressive, more cost-effective approach to VTE prophylaxis should be vetted with larger randomized trials.”
Researchers performed a retrospective review of data for 1,917 patients who underwent primary and revision TJAs. There were 742 patients who underwent primary TKAs and 326 patients underwent revision TKAs. There were also 608 patients who underwent primary THAs and 241 patients who underwent revision THAs. Investigators reviewed individual records for demographics, medical comorbidities, chemoprophylaxis type, venous thromboembolism risk factors, intraoperative data and postoperative complications. The rate of VTE and wound complications were compared between the anticoagulant therapy types used after surgery.
Of the prophylactic agents used, the most common was rivaroxaban (40.6%), then warfarin (28.5%) and aspirin (27.6%). No correlation was seen between the type of chemoprophylaxis used and postoperative VTE or wound drainage. Investigators noted revision surgery was an independent risk factor for wound drainage; however, it was not a risk factor for VTE.
Investigators found an increased VTE rate did not correlate with revision arthroplasty alone. They also noted that aspirin was an effective chemoprophylactic agent compared to other agents and did not increase the risk the bleeding in patients who were at low risk.
“The data didn’t really support any one of three modalities per se. None of the anticoagulants were favored, our results just said they did pretty well,” Brett Levine, MD, said in an interview with Healio.com/Orthopedics. “As far as impacting how I treat patients, I would say I am more apt to consider stratifying patients at this point and since all three work equally as well, l considers the extent of the revision procedure and the overall strength and health of the patient. This opens the door to treat patients in a teared fashion, whereby; a healthy patient with simple revision will get aspirin, whereas a larger revision in not as healthy of an individual will get a stronger anticoagulant.”– by Monica Jaramillo
Disclosures: The researchers report no relevant financial disclosures.
Read more about
Click Here to Manage Email Alerts