Low-dose aspirin may be safe, effective for prevention of venous thromboembolism after TKA
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Key takeaways:
- The proportion of patients receiving low-dose aspirin increased from 7.65% in 2012 to 55.29% in 2022.
- A low-dose aspirin-only regimen was associated with reduced odds of several postoperative complications.
Results from a large cohort study showed low-dose aspirin may be a safe and effective prophylaxis for the prevention of venous thromboembolism following total knee arthroplasty.
“Low-dose aspirin was superior to other chemoprophylactic agents for the prevention of [venous thromboembolism] VTE in terms of both safety and efficacy in all patients across VTE risk profiles,” the researchers wrote in the study. “Low-dose aspirin-only prophylaxis was associated with reductions in several postoperative complications for both high- and low-risk patients, including bleeding events, postoperative infections, ED visits and readmissions, which may explain the substantial increase in its utilization in recent years across patient risk profiles.”
Researchers collected electronic health record data from a national database on 126,692 adults who underwent TKA with chemoprophylaxis between 2012 and 2022. After excluding those who received high-dose aspirin chemoprophylaxis, researchers categorized patients depending on whether they were high-risk (n = 50,547) or low-risk (n = 43,177) for VTE.
Outcomes measured included proportion of patients who received low-dose aspirin vs. other chemoprophylaxis, as well as incidence of deep vein thrombosis, pulmonary embolus (PE), hemorrhage, hematoma, gastrointestinal bleeding, periprosthetic joint infection, surgical site infection (SSI), myocardial infarction (MI), stroke, mortality, revisions, ED visits and readmissions in the 90-day postoperative period.
Researchers found the proportion of patients receiving low-dose aspirin increased from 7.65% in 2012 to 55.29% in 2022, while the proportion of patients receiving other forms of chemoprophylaxis decreased from 96.25% in 2012 to 42.98% in 2022.
In the high-risk cohort, patients had reduced incidences of DVT, PE, gastrointestinal bleeding, hematoma and hemorrhage when receiving low-dose aspirin-only prophylaxis vs. other anticoagulants. In addition, the odds of SSI, mortality, MI, stroke, ED visits, revisions and readmissions were reduced in the high-risk cohort receiving low-dose aspirin-only vs. other regimens.
For low-risk patients, risks for PJI, SSI, MI, revisions, ED visits and readmissions were reduced when receiving low-dose aspirin-only regimens vs. additional anticoagulants.
“Our findings support the recommendations of the [International Consensus Meeting on Venous Thromboembolism] ICM-VTE by showing that low-dose aspirin is a safe and effective method of prophylaxis for patients of all risk profiles undergoing joint arthroplasty,” the researchers wrote. “As aspirin is an inexpensive, well-tolerated medication that requires minimal observation, it is also likely to be the most cost-effective measure.”
They added, “Further studies should explore this hypothesis further as orthopedic surgeons continue to optimize costs and improve clinical outcomes.”
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