title: Safety and efficacy of multimodal thromboprophylaxis following total knee arthroplasty: a comparative study of preferential aspirin vs. routine coumadin chemoprophylaxis.
abstract: Multimodal thromboprophylaxis encompasses preoperative VTE risk stratification, regional anesthesia, mechanical prophylaxis, and early mobilization. We determined if aspirin can be safely used for adjuvant chemoprophylaxis in patients who have a low thromboembolic risk. 1016 consecutive patients undergoing TKA received multimodal thromboprophylaxis. Aspirin was used in 67% of patients and Coumadin 33% (high risk patients, or who were on Coumadin before surgery). This study group was compared to 1001 consecutive patients who received multimodal thromboprophylaxis and routine Coumadin chemoprophylaxis. There was no significant difference in rates of VTE, PE, bleeding, complications, readmission and 90-day mortality between the two groups. There was a significantly higher rate of wound related complications in the control group (p=0.03). Multimodal thromboprophylaxis with aspirin given to the majority of patients at a low VTE risk is safe and effective in patients undergoing primary TKA.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Gesell
authors.forename: Alejandro
authors.initials: A
authors.lastname: González Della Valle
authors.forename: Sergio
authors.initials: S
authors.lastname: Bartolomé García
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Steven B
authors.initials: SB
authors.lastname: Haas
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Salvati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D018890:Chemoprevention; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin