Speaker: Aspirin is an acceptable thromboprophylaxis agent in orthopedic trauma patients

Issue: November 2022

ByMax R. Wursta

Fact checked byGina Brockenbrough, MA

TAMPA, Fla. —Aspirin as a thromboprophylaxis agent was noninferior to low-molecular-weight heparin for all-cause mortality in patients with extremity, pelvic or acetabular fractures, presented results showed.

“Venous thromboembolism (VTE) is a well-recognized, potentially fatal complication after orthopedic trauma. Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis,” Robert V. O’Toole, MD, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “However, arthroplasty literature suggests aspirin may be equally effective as LMWH for VTE prevention. Patients strongly prefer aspirin because of its pill form and because of its cost — if it has acceptable performance regarding the prevention of death.”

Infographic showing statistics of 90-day all-cause mortality — Further, researchers found no differences in PE, death due to PE, proximal DVT, infections or complications between the cohorts. Data were derived from Toole RV, et al. Paper 83. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 12-15, 2022; Tampa, Fla.

From April 2017 to August 2021, O’Toole and colleagues in the Major Extremity Trauma Research Consortium (METRC) randomly assigned 6,110 patients (mean age of 44.7 years) to receive a twice-daily administration of LMWH (30 mg of enoxaparin) and 6,101 patients to receive a twice-daily administration of 81 mg of aspirin. Outcome measures included 90-day all-cause mortality, 90-day infection rates, pulmonary embolism (PE), deep vein thrombosis (DVT) and complications due to bleeding or wound healing.

Robert V. O'Toole

At 90 days, the aspirin cohort had an all-cause mortality of 0.78% (n = 47), while the LMWH cohort had an all-cause mortality of 0.73% (n = 45). Researchers found no differences in PE, death due to PE, proximal DVT, infections or complications between the cohorts. However, O’Toole noted a slight difference in distal DVT in the LMWH cohort (1.5%) compared with the aspirin cohort (0.9%).

“Aspirin is an acceptable thromboprophylaxis agent in orthopedic trauma patients. This is because it was noninferior for all-cause mortality,” O’Toole said. “Clinicians, patients and hospitals should consider these data when determining VTE prophylaxis,” he added.

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Sources/Disclosures

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Source:

O’Toole RV, et al. Paper 83. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 12-15, 2022; Tampa, Fla.

Disclosures: O’Toole reports being a paid consultant for Imagen, Lincotek and Stryker; being a paid presenter or speaker for Zimmer; receiving IP royalties from Lincotek; and receiving stock or stock options in Imagen.

Orthopaedic Trauma Association Annual Meeting

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Speaker: Aspirin is an acceptable thromboprophylaxis agent in orthopedic trauma patients

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