title: A prospective comparison of warfarin to aspirin for thromboprophylaxis in total hip and total knee arthroplasty.
abstract: Current orthopedic practice requires consideration of contradictory recommendations regarding pulmonary embolism (PE) prevention among patients undergoing total hip arthroplasty (THA) and knee joint arthroplasty (TKA). A total of 696 consecutive patients underwent elective THA or TKA. Two hundred eighty-one patients received PE risk stratification per American Academy of Orthopaedic Surgeons guidelines. Of these patients, 152 standard-risk patients received aspirin, and 129 elevated-risk patients received warfarin. The comparator group of 415 patients received American College of Chest Physicians-recommended warfarin without PE risk stratification. Primary study outcomes were symptomatic PE, deep venous thrombosis, major bleeding, and death. The rate of symptomatic PE and venous thromboembolism among standard-risk group patients receiving aspirin was greater than the comparator group (4.6% vs 0.7% and 7.9% vs 1.2%, respectively). Most events (16/18) occurred among patients undergoing TKA. Patients with total joint arthroplasty at standard risk for PE receiving aspirin had a higher rate of symptomatic PE and venous thromboembolism than did patients receiving anticoagulation.
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin