Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol.
OBJECTIVE
Multimodal thromboprophylaxis includes preoperative thromboembolic risk stratification and autologous blood donation, surgery performed under regional anaesthesia, postoperative rapid mobilisation, use of pneumatic compression devices and chemoprophylaxis tailored to the patient's individual risk. We determined the 90-day rate of venous thromboembolism (VTE), other complications and mortality in patients who underwent primary elective hip and knee replacement surgery with multimodal thromboprophylaxis.


METHODS
A total of 1,568 consecutive patients undergoing hip and knee replacement surgery received multimodal thromboprophylaxis: 1,115 received aspirin, 426 received warfarin and 27 patients received low molecular weight heparin and warfarin with or without a vena cava filter.


RESULTS
The rate of VTE, pulmonary embolism, proximal deep vein thrombosis (DVT) and distal DVT was 1.2, 0.36, 0.45 and 0.36 %, respectively, in patients who received aspirin. The rates in those who received warfarin were 1.4, 0.9, 0.47 and 0.47 %, respectively. The overall 90-day mortality rate was 0.2 %.


CONCLUSIONS
Multimodal thromboprophylaxis in which aspirin is administered to low-risk patients is safe and effective following primary total joint replacement.
Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Ettore
E
Vulcano
Mark
M
Gesell
Amanda
A
Esposito
Yan
Y
Ma
Stavros G
SG
Memtsoudis
Alejandro
A
Gonzalez Della Valle
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000401:mortality; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality; D001241:Aspirin / Q000627:therapeutic use*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin