Low-Dose Aspirin Is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Hip Arthroplasty: A Retrospective Cohort Study

Venous Thromboembolism Prophylaxis After Revision Hip Arthroplasty: A Multicenter Analysis of Anticoagulant Choice and Weight-Bearing Status

BACKGROUND

Aspirin (ASA) is a reliable prophylactic agent for venous thromboembolism (VTE) in revision total hip arthroplasty (THA). While several studies have compared ASA to other anticoagulants, to our knowledge, none have evaluated its effectiveness in patients who have restricted weight-bearing status (WBS). Limited mobilization after surgery increases the risk of VTE complications. This study aimed to assess the effects of WBS and anticoagulant choice on the rates of thrombotic and bleeding complications after revision of THA.

METHODS

We reviewed 3,000 revision THAs performed between 2019 and 2022 across four institutions. Data collected included demographic factors, comorbidities, indication for revision, WBS (weight bearing as tolerated [WBAT] versus non-WBAT), anticoagulant choice, and Caprini VTE risk assessment score. Incidences of VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), drainage, hematoma, and periprosthetic joint infections were recorded. Multivariate logistic regression was used to evaluate the associations between postoperative thrombotic and bleeding events, prophylactic pharmacologic agents, and WBS.

RESULTS

The incidence of VTE, DVT, and PE was significantly lower in the ASA cohort compared to the non-ASA cohort (VTE: 1.2 versus 3.5%, P < 0.001; DVT: 0.9 versus 3.3%, P < 0.001; PE: 0.2 versus 0.9%, P < 0.001). Within the ASA cohort, the incidence of VTE (1.1 versus 1.1%), bleeding complications (4.5 versus 4.5%), and periprosthetic joint infection (5.1 versus 5.8%) were similar when stratified by WBAT and non-WBAT. Multivariate regression demonstrated that ASA prophylaxis decreased the likelihood of VTE compared to non-ASA (odds ratio: 0.35, confidence interval: 0.19 to 0.57, P < 0.001). Weight-bearing status was not a risk factor regarding VTE or bleeding events.

CONCLUSIONS

Aspirin is a safe and effective prophylactic option for VTE in revision THA, regardless of WBS. While the lower VTE incidence in the ASA group suggests efficacy, potential selection bias must be considered.

Low-versus high-dose aspirin for venous thromboembolic prophylaxis after total joint arthroplasty: a systematic review and meta-analysis

BACKGROUND

The adverse effects of aspirin are dose-dependent, and there is controversy surrounding the use of low-dose (LD) aspirin to prevent venous thromboembolism (VTE) following total joint arthroplasty (TJA). This meta-analysis sought to compare the efficacy and complication rate of low-dose (162 mg per day) versus high-dose (HD, 650 mg per day) aspirin after TJA surgery.

METHODS

In four main databases, we searched from inception until September 2024 for articles comparing the rate of VTE following TJA(TKA/THA) using only aspirin chemoprophylaxis with different dosages. We meta-analyzed and compared the VTE and complication rates of LD aspirin (162 mg per day) with HD aspirin (650 mg per day) and presented our results as odds ratio (ORs) in forest plot diagrams.

RESULTS

There were 14 eligible studies, comprising 43,518 patients in the LD group and 62,645 patients in the HD group. DVT (OR: 1.37, CI: 0.93-2.02, P = 0.11) and PE (OR: 1.86, CI: 0.73-4.72, P = 0.19) rates were similar between the groups. However, taking VTE as the total number of cases with DVT or PE, the incidence was significantly higher in the HD group than in the LD group (OR:1.53, CI: 1.17-2.00, P = 0.002). HD also had a significantly higher rate of PJI (OR:2.68 CI:1.5-4.6 P = 0.001), but gastrointestinal bleeding (GIB) was similar between the two groups (OR: 0.97, CI: 0.42-2.22, P = 0.95).

CONCLUSION

The findings suggest that LD aspirin may be a viable option for VTE chemoprophylaxis following TJA, potentially offering comparable efficacy with a lower risk of PJI compared to HD aspirin regimens.

LEVEL OF EVIDENCE

Therapeutic Level II.

Efficacy and Safety of Catheter Interventions for Postoperative Urinary Retention After Primary Hip and Knee Total Joint Arthroplasty

INTRODUCTION

Postoperative urinary retention (POUR) is a common barrier to rapid-discharge hip and knee total joint arthroplasty (TJA). We evaluated the efficacy and safety of catheterization intervention methods for POUR before and after discharge.

METHODS

A total of 1,659 primary TJAs were retrospectively reviewed. POUR resolutions before and after discharge were evaluated relative to catheterization type and other covariates. Complications before and within 90 days of discharge were quantified. A total of 113 POUR cases comprised the analysis sample of 76 hips and 37 knees in 51 women and 62 men with an average age and body mass index of 68.6 (range 22 to 92) years and 31.7 (range 16 to 49) kg/m 2 .

RESULTS

POUR resolved before discharge for 82.3% (93/113) of patients, with equivalent resolution rates for intermittent catheterization alone (84.2%, 32/38) compared with indwelling catheterization with or without intermittent catheterization (82.6%, 57/69, P < 0.999), equivalent time to resolution ( P = 0.319), and no difference in complication rates ( P = 0.999). Complication rates within 90 days of discharge were higher for patients treated with indwelling catheters before discharge ( P = 0.049). Resolution before discharge was more likely with increasing body mass index ( P = 0.026) and less likely for patients with a history of urinary retention ( P = 0.033). 60 percent (12/20) of patients with unresolved POUR were discharged with self-intermittent catheterization and 40% (8/20) with indwelling catheters, with no differences in efficacy and safety based on the catheterization type ( P = 0.109).

DISCUSSION

Before discharge, we observed equivalent resolution rates and equivalent time to resolution for indwelling and intermittent catheterization alone without compromising patient safety. Intermittent catheterization is favored, however, because in situ catheter exposure is dramatically reduced and postdischarge complication rates are lower. Additional research is needed to develop evidence-based POUR guidelines for outpatient TJA.

Aspirin is an Effective Prophylaxis for Venous Thromboembolism After Revision Hip and Knee Arthroplasty

BACKGROUND

Venous thromboembolism (VTE) following revision total joint arthroplasty (TJA) poses significant risks despite prophylactic measures. The optimal VTE prophylaxis agent for revision TJA remains unclear. This study aimed to compare aspirin against various anticoagulant agents regarding efficacy and safety in preventing symptomatic VTE events after revision TJA.

METHODS

A retrospective analysis included 4,575 patients undergoing revision TJA between 2008 and 2020. Of these, 2,091 received aspirin, while 2,484 received other anticoagulants. Demographic, procedural, and outcome data were collected. Logistic regression models were used to identify predictors of symptomatic VTE.

RESULTS

The aspirin group showed a significantly lower incidence of symptomatic VTE compared to the other anticoagulant group (0.53 versus 2.54%, P < .001). Logistic regression confirmed a higher risk of VTE with other anticoagulants (odds ratio: 0.2 to 0.26, P < .001), while blood transfusion (odds ratio: 2.72, P = .001) were identified as risk factors.

CONCLUSIONS

This study demonstrated that aspirin is a viable and potentially safer option than other anticoagulants, exhibiting comparable efficacy in preventing VTE events in revision TJA. Balancing effectiveness and safety is crucial, considering patient-specific risk factors and bleeding tendencies. This large cohort study demonstrated that aspirin was associated with a more effective and safer VTE prophylaxis agent, compared to other anticoagulants, in patients undergoing revision TJA.

Predictors of Failure to Achieve Planned Same-Day Discharge after Primary Total Joint Arthroplasty: a Multivariable Analysis of Perioperative Risk Factors

INTRODUCTION

Failure to achieve planned same-day discharge (SDD) primary total joint arthroplasty (TJA) occurs in as many as 7% to 49% of patients in the United States. This study evaluated the association between 43 perioperative risk factors and SDD failure rates.

METHODS

A retrospective analysis of prospectively collected data from 466 primary TJAs with planned SDD to home was performed. Surgeries were performed at an academic tertiary care center comprising a hospital facility and a stand-alone ambulatory surgery center (ASC) on the same campus. Factors associated with failed SDD were identified using a multivariable analysis.

RESULTS

Only one of 316 (0.3%) patients who underwent surgery in the ASC failed planned SDD ( P < 0.001) compared with 33.3% of 150 patients who underwent surgery in the hospital. The ASC failure was because of pain that interfered with physical therapy. Sixty-two percent (n = 31) of hospital failures were attributed to medical complications, 24% (n = 12) to physical therapy clearance, 8% (n = 4) to not being seen by internal medicine or therapy on the day of surgery, and 6% (n = 3) to unknown causes. Failure was increased in patients with preoperative anemia ( P = 0.003), nonwhite patients ( P = 0.002), patients taking depression/anxiety medication ( P = 0.015), and for every 10-morphine milligram equivalent increase in opioids consumed per hour in the postacute care unit ( P = 0.030).

DISCUSSION

Risk stratification methods used to allocate patients to ASC versus hospital outpatient TJA surgery predicted SDD success. Most failures were secondary to medical causes. The findings of this study may be used to improve perioperative protocols enabling the safe planning and selection of patients for SDD pathways.

Trends in deep vein thrombosis prophylaxis after total hip arthroplasty: 2016 to 2021

Introduction

Venous thromboembolism (VTE) has long been acknowledged as a potential complication of total hip arthroplasty (THA) contributing to heightened patient morbidity, mortality, and substantial healthcare costs. We aimed to: 1) assess trends in VTE prophylaxis utilization between 2016 and 2021; 2) determine the incidence of postoperative VTE and transfusions; and 3) identify independent risk factors for 90-day VTE and transfusion risks following THA in relation to the use of aspirin, dabigatran, enoxaparin, rivaroxaban, and warfarin.

Methods

A national, all-payer database was queried from January 1, 2016 and December 31, 2022. Use trends for aspirin, enoxaparin, rivaroxaban, dabigatran, and warfarin as thromboprophylaxis following THA was assessed. Incidence of ninety-day postoperative outcomes assessed included rates of 90-day postoperative VTE and transfusion.

Results

From 2016 to 2021, aspirin (n = 36,346) was the most used agent for VTE prophylaxis after THA, followed by dabigatran (n = 13,065), rivaroxaban (n = 11,790), enoxaparin (n = 11,380), and warfarin (n = 6326). Independent risk factors for 90-day VTE included CKD, COPD, CHF, obesity, dabigatran, enoxaparin, rivaroxaban, and warfarin (all p < 0.05).

Conclusion

Aspirin was used with increasing frequency and demonstrated lower rates of VTE and transfusion following THA, compared to dabigatran, enoxaparin, rivaroxaban, and warfarin. These findings seem to indicate that the increasing use of aspirin in VTE prophylaxis has been accomplished in appropriately selected patients.

Comparison of low-dose (162 mg) and high-dose (650 mg) Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study

Since Aspirin's adverse effects are dose-dependent, and evidence supporting the use of low-dose (LD) Aspirin in preventing venous thromboembolism (VTE) after total hip arthroplasty (THA) is weak, the authors do not know what the minimal effective dosage of Aspirin is to prevent VTE. This study aimed to compare the rates of 90-day symptomatic VTE following THA and total knee arthroplasty in healthy patients taking LD Aspirin vs. high-dose (HD) Aspirin for 6 weeks postoperatively.

MATERIALS AND METHODS

A prospective cohort of patients with THA and total knee arthroplasty was conducted at two tertiary centres. Symptomatic VTE within 90 days of index arthroplasty was the primary outcome; gastrointestinal bleeding (GIB) and mortality were secondary outcomes.

RESULTS

The final analysis included 312 consecutive patients: 158 in the LD group and 154 in the HD group. Two groups were similar regarding preoperative data, including sex, age, BMI, smoking, diabetes mellitus, Hgb and platelet count, and type of surgery. The LD group had one deep vein thrombosis (0.6%), and the HD group had two (1.3%) (P=0.62). Neither group had PTE. Therefore, VTE rates are the same as deep vein thrombosis rates and similar between the groups (0.6% vs. 1.3%, P=0.62)Regarding GIB due to anticoagulant therapy, no patient in the LD group reported GIB, whereas two (1.3%) patients in the HD group reported GIB within 90 days of arthroplasty. GIB rates did not differ significantly between groups (P=0.24). Considering VTE + GIB combined, the HD groups showed a higher rate of complications (N=4, 2.6%) than the LD groups (N=1, 0.6%) but not statistically significant (P=0.21).

CONCLUSIONS

Prophylactic administration of Aspirin with low doses (81 mg BID) and high doses (325 mg BID) for six weeks is equally effective at reducing VTE in total joint arthroplasty patients and had similar adverse effects.

LEVEL OF EVIDENCE

Therapeutic Level II.

Aspirin thromboprophylaxis following primary total knee arthroplasty is associated with a lower rate of early prosthetic joint infection compared with other agents

BACKGROUND

Patients undergoing total knee arthroplasty (TKA) are at increased risk of venous thromboembolism (VTE). Aspirin has been shown to be effective at reducing rates of VTE. In select patients, more potent thromboprophylaxis is indicated, which has been associated with increased rates of bleeding and wound complications. This study aimed to evaluate the effect of thromboprophylaxis choice on rates of early prosthetic joint infection (PJI) following TKA.

METHODS

A review of 11,547 primary TKA patients from 2013 to 2019 at a single academic orthopaedic hospital was conducted. The primary outcome measure was PJI within 90 days of surgery as measured by Musculoskeletal Infection Society criteria. There were 59 (0.5%) patients diagnosed with early PJI. Chi-square and Welch-Two Sample t-tests were used to determine statistically significant relationships between thromboprophylaxis and demographic variables. Significance was set at p<0.05. Multivariate logistic regression adjusted for age, body mass index, sex, and Charlson comorbidity index was performed to identify and control for independent risk factors for early PJI.

RESULTS

There was a statistically significant difference in the rates of early PJI between the aspirin and non-aspirin group (0.3 vs 0.8%, p<0.001). Multivariate logistic regressions revealed that patients given aspirin thromboprophylaxis had significantly lower odds of PJI (odds ratios (OR)=0.51, 95% Confidence Interval (CI) 0.29 to 0.89, p=0.019) compared to non-aspirin patients.

CONCLUSIONS

The use of aspirin thromboprophylaxis following primary TKA is independently associated with a lower rate of early PJIs. Arthroplasty surgeons should consider aspirin as the gold standard thromboprophylaxis in all patients in which it is deemed medically appropriate and should carefully weigh the morbidity of PJI in patients when non-aspirin thromboprophylaxis is considered.

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience

Background

With hospital inpatient capacity increasingly limited and primary total joint arthroplasty (TJA) rapidly transitioning to outpatient settings, the feasibility of outpatient aseptic revision and conversion TJA (rTJA) has been considered. Before the widespread adoption of outpatient rTJA, guidelines must be established to prevent patient harm. To this end, this study describes our initial experience with same-day-discharge (SDD) aseptic rTJA.

Methods

All aseptic rTJAs performed between May 8, 2015, and December 30, 2021, were retrospectively reviewed. Revision indications, patient selection criteria, and outcomes including SDD success rate, predischarge complications, all-cause emergency department visits, inpatient readmissions, and unplanned clinic encounters within 90 days of surgery were recorded.

Results

Thirty-five SDD aseptic rTJAs were performed. Conversion total hip arthroplasty (55.0%) and instability (27.3%) were the most common indications for hip revision. Instability (50%) and conversion total knee arthroplasty (20.8%) were most common for knee revision. SDD was achieved in 97% (34/35) of cases. One hip patient failed SDD due to persistent hypoxia requiring an overnight hospital stay and also underwent closed reduction for dislocation in the emergency department within 90 days of discharge. Two additional patients had unplanned clinic encounters within 90 days of the index procedure. There were no hospital readmissions or reoperations within 90 days.

Conclusions

Our initial experience suggests SDD aseptic rTJA can be safe and effective when modern perioperative outpatient protocols and surgical techniques are implemented. Future studies should further define patient selection criteria to optimize outcomes and minimize complications in this population.

Incidence and risk factors associated with venous thromboembolism following primary total hip arthroplasty in low-risk patients when using aspirin for prophylaxis

AIMS

The primary aim was to assess the incidence of venous thromboembolism (VTE) following total hip replacements (THR) in a low-risk patient group when using 150 mg aspirin as the pharmacological component of VTE prophylaxis on discharge. The secondary aim was to identify factors associated with an increased risk of a VTE event in this low-risk group.

PATIENTS AND METHODS

Retrospective review of a consecutive cohort of patients undergoing THR during a 63-month period. Patient demographics, socio-economic status, ASA grade, type of anaesthetic, length of surgery and BMI were recorded. A diagnosis of VTE was assigned to symptomatic patients with positive imaging for a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE) within 8 weeks of surgery. Multivariate logistic regression modeling was used to identify factors associated with VTE after THR.

RESULTS

3880 patients underwent THR during the study period, of which 2740 (71%) were low risk and prescribed aspirin for VTE prophylaxis. There were 34 VTE events, of which 15 were DVTs and 18 were PEs, with 1 patient diagnosed with both. The incidence of VTE was 1.2%, with no VTE-related deaths. Patients incurring a VTE postoperatively were more likely to be male (odds ratio [OR] 2.06, p = 0.022), of older age (OR 0.43, p = 0.047) and were more likely to be socially deprived (OR 0.32, p = 0.006). There was no significant difference with patients given low-molecular-weight heparin (LMWH) as an inpatient prior to discharge on aspirin (p = 0.806), nor any difference with the type of anaesthetic used during surgery (p = 0.719).

CONCLUSIONS

Aspirin is a relatively safe and effective choice for VTE prophylaxis in low-risk patients undergoing THR. Male sex and age >70 years were twice as likely to sustain a VTE and patients from the most deprived socio-economic background are 3 times as likely.

Postoperative venous thromboembolism event increases risk of readmissions and reoperation following total joint arthroplasty: a propensity-matched cohort study

PURPOSE

The clinical impact of postoperative venous thromboembolism (VTE) following total joint arthroplasty (TJA) remains unclear. In this study, we evaluate the effect of VTE following TJA on postoperative outcomes including discharge disposition, readmission rates, and revision rates.

METHODS

We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA or TKA between 2013 and 2020. Patients were stratified into two cohorts based on whether or not they had a VTE following their procedure. Baseline patient demographics and clinical outcomes such as readmissions and revisions were collected. Propensity score matching was performed to limit significant demographic differences, while independent sample t-tests and Pearson's chi-squared test were used to compare outcomes of interest between the groups.

RESULTS

After propensity score matching, there were 109 patients in each cohort, representing a total of 218 patients for the matched comparison. Prior to matching, the VTE cohort was noted to have a significantly higher BMI than the non-VTE cohort (32.22 ± 6.27 vs 30.93 ± 32.04 kg/m², p = 0.032). All other patient demographics were similar. Compared to the non-VTE cohort, the VTE cohort was less likely to be discharged home (66.1% vs 80.7%; p = 0.021), had a higher rate of 90-day all-cause readmissions (27.5% vs 9.2%, p = 0.001), and a higher two-year revision rate (11.0% vs 0.9%, p = 0.003).

CONCLUSION

Patients with postoperative VTE were less likely to be discharged home and had higher 90-day readmission and two-year revision rates. Therefore, mitigating perioperative risk factors, initiating appropriate long-term anticoagulation, and maintaining close follow-up for patients with postoperative VTE may play significant roles in decreasing hospital costs and the economic burden to the healthcare system.

LEVEL OF EVIDENCE III

Retrospective Cohort Study.

Aspirin Use for Venous Thromboembolism Prevention Is Safe and Effective in Overweight and Obese Patients Undergoing Revision Total Hip and Knee Arthroplasty

BACKGROUND

Venous thromboembolism (VTE), defined as pulmonary embolism or deep venous thrombosis, is a rare but serious complication following revision total hip arthroplasty (RTHA) and revision total knee arthroplasty (RTKA). Previous studies show that obesity may be associated with an increased risk for pulmonary embolism, wound complications, and infection. With no current universal standard of care for VTE prophylaxis, we sought to determine whether aspirin prescribed (ASA) is safe and effective in obese patients undergoing RTHA/RTKA.

METHODS

A retrospective review of 1578 consecutive RTHA/RTKA cases (751 RTHAs and 827 RTKAs) was conducted identifying patients prescribed 325 or 81 mg ASA. Ninety-day postoperative VTE rates, bleeding, wound complications, deep infections, and mortality were collected. Cohorts were stratified according to body mass index (BMI): normal (18-24.9 kg/m²), overweight (25-29.9 kg/m²), obese (30-34.9 kg/m²), severely obese (35-39.9 kg/m²), and morbidly obese (≥40 kg/m²).

RESULTS

The cohort comprised of 335 patients with a normal BMI, 511 were overweight, 408 obese, 232 severely obese, and 92 morbidly obese. Total VTE rates were statistically similar between BMI groups (0.90% vs 0.78% vs 0.74% vs 0.43% vs 0%, P = .89). There were no differences in bleeding rates (0.90% vs 0% vs 0% vs 0.43% vs 0%, P = .08), wound complications (0.30% vs 0.20% vs 0.25% vs 0% vs 0%, P = .93), infection (1.49% vs 1.57% vs 0.98% vs 1.29% vs 1.09%, P = .66), or mortality (0% vs 0.20% vs 0% vs 0% vs 0%, P = .72).

CONCLUSION

ASA is safe and effective for VTE prevention in obese patients with similar complication rates to nonobese patients undergoing RTHA/RTKA.

Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Revision Hip and Knee Arthroplasty as Reported by American Board of Orthopaedic Surgery Part II Candidates

BACKGROUND

The optimum venous thromboembolism (VTE) prophylaxis strategy to minimize risk of VTE and bleeding complications following revision total hip and knee arthroplasty (rTHA/rTKA) is controversial. The purpose of this study is to describe current VTE prophylaxis patterns following revision arthroplasty procedures to determine efficacy, complication rates, and prescribing patterns for different prophylactic strategies.

METHODS

The American Board of Orthopaedic Surgery Part II (oral) examination case list database was analyzed. Current Procedural Terminology codes for rTHA/rTKA were queried and geographic region, VTE prophylaxis strategy, and complications were obtained. Less aggressive prophylaxis patterns were defined if only aspirin and/or sequential compression devises were utilized. More aggressive VTE prophylaxis patterns were considered if any of low-molecular-weight heparin (enoxaparin), warfarin, rivaroxaban, fondaparinux, or other strategies were used.

RESULTS

In total, 6387 revision arthroplasties were included. The national rate of less aggressive VTE prophylaxis strategies was 35.3% and more aggressive in 64.7%. Use of less aggressive prophylaxis strategy was significantly associated with patients having no complications (89.8% vs 81.9%, P < .001). Use of more aggressive prophylaxis patterns was associated with higher likelihood of mild thrombotic (1.2% vs 0.3%, P < .001), mild bleeding (1.7% vs 0.6%, P < .001), moderate thrombotic (2.6% vs 0.4%, P < .001), moderate bleeding (6.2% vs 4.0%, P < .001), severe bleeding events (4.4% vs 2.4%, P < .001), infections (6.4% vs 3.8%, P < .001), and death within 90 days (3.1% vs 1.3%, P < .001). There were no significant differences in rates of fatal pulmonary embolism (0.1% vs 0.04%, P = .474). Subgroup analysis of rTHA and rTKA patients showed similar results.

CONCLUSION

The individual rationale for using a more aggressive VTE prophylaxis strategy was unknown; however, more aggressive strategies were associated with higher rates of bleeding and thrombotic complications. Less aggressive strategies were not associated with a higher rate of thrombosis.

LEVEL OF EVIDENCE

Therapeutic Level III.

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Background

Deep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty(THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA.

Methods

Patients who underwent THA in our hospital from January 1, 2017 to November 30, 2020 were included. The personal characteristics and clinical data of DVT and no-DVT patients were compared and analyzed. Logistic regression analyses were perfomed to identify the potential risk factors of DVT in patients with THA.

Results

A total of 182 THA patients were included, the incidence of DVT of lower limb in patients with THA was 19.78 %. There were significant differences in the age, BMI, diabetes, number of replacement, duration of surgery, type of prosthesis and duration of days in bed between DVT and no-DVT patients(all P < 0.05). And there were no significant differences in the gender, hypertension, hyperlipidemia, preoperative D-dimer, type of anesthesia and anticoagulant drugs use(all P > 0.05). Logistic regression analysis indicated that age > 70y(OR4.406, 95 %CI1.744 ~ 6.134), BMI ≥ 28(OR2.275, 95 %CI1.181 ~ 4.531), diabetes(OR3.949, 95 %CI1.284 ~ 5.279), bilateral joint replacements(OR2.272, 95 %CI1.402 ~ 4.423), duration of surgery ≥ 120 min(OR3.081, 95 %CI1.293 ~ 5.308), cemented prosthesis(OR2.435, 95 %CI1.104 ~ 4.315), and duration of days in bed > 3 days(OR1.566, 95 %CI1.182 ~ 1.994) were the risk factors of DVT of lower limb in patients with THA.

Conclusions

DVT in the lower limb after THA is common, and its onset is affected by many factors. In clinical work, attention should be paid to identify the risk factors for DVT and targeted interventions are highlighted to prevent the postoperative DVT.

Does venous thromboembolism prophylaxis affect the risk of venous thromboembolism and adverse events following primary hip and knee replacement? A retrospective cohort study

BACKGROUND

The optimum chemical venous thromboembolism (VTE) prophylactic agents following total hip and knee replacement (THR and TKR) remain unknown. NICE recommends multiple agents, including direct oral anticoagulants (DOACs), low-molecular weight heparin (LMWH), and aspirin. We assessed whether VTE prophylaxis affected the risk of VTE and adverse events following primary THR and TKR.

MATERIALS AND METHODS

We reviewed 982 elective primary THRs (59%) and TKRs (41%) at a large tertiary centre during 2018. The primary outcome was any VTE (DVT and/or PE) within 90-days. Secondary outcomes were adverse events within 90-days (major bleeding and wound complications). The association between VTE prophylaxis and outcomes was assessed.

RESULTS

The overall prevalence of VTE and adverse events were 2.7% (n = 27) and 15.2% (n = 136) respectively. The most common agents used were DOAC ± LMWH (50.7%, n = 498), followed by aspirin ± LMWH (35.5%, n = 349) and LMWH alone (4.7%, n = 46). The risk of VTE (aspirin ± LMWH = 3.7%, DOAC = 2.0%, LMWH = 2.2%) was not significantly different between agents (p = 0.294). The risk of any adverse event was significantly higher (p < 0.001) with aspirin ± LMWH (16.1%; n = 56) and LMWH (28.3%; n = 13) compared with DOACs ± LMWH (7.0%; n = 35) in TKRs only, there was no differences between agents for adverse events in THRs (p = 0.644).

CONCLUSIONS

Choice of thromboprophylaxis did not influence the risk of VTE following primary THR and TKR. DOACs (+/- LMWH) were associated with the lowest risk of adverse events. Large multicentre trials are still needed to assess the efficacy and safety of these agents following THR and TKR.

Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?

INTRODUCTION

Acetylsalicylic acid (aspirin) is a commonly prescribed medication, especially in the age group of individuals who undergo elective total hip arthroplasty (THA). Preoperative discontinuation of aspirin is believed to reduce intraoperative bleeding and other complications, but it may increase the risk of perioperative cardiovascular events. In this study we have sought to evaluate the safety of continuous aspirin treatment in patients undergoing elective THA.

MATERIALS AND METHODS

This is a retrospective analysis of a consecutive cohort who underwent elective THA in a tertiary medical center between 2011 and 2018. The cohort was divided into two groups-one that received continuous preoperative aspirin treatment and one that did not. Blood loss, peri- and postoperative complications, readmissions, and short- and long-term mortality were compared between groups.

RESULTS

Out of 757 consecutive patients (293 males, 464 females) who underwent elective primary THA, 552 were in the "non-aspirin" group and 205 were in the "aspirin" group and were not treated preoperative with other medication affecting hemostasis. Perioperative continuation of aspirin treatment did not significantly increase perioperative bleeding, as indicated by changes in hemoglobin levels (P = 0.72). There were no significant differences in short- and long-term mortality (P = 0.47 and P = 0.4, respectively) or other perioperative complications, such as readmission (P = 0.78), deep or superficial infection (P = 1 and P = 0.47, respectively), and cardiovascular events (none in both groups).

CONCLUSION

Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. The protective effects of aspirin from postoperative thrombotic and cardiovascular events are well documented. The current findings dispute the need to preoperatively withhold aspirin treatment in patients undergoing elective primary THA.