title: Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients.
abstract: OBJECTIVE
  The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis.
  
  
  METHODS
  We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR).
  
  
  RESULTS
  The incidence of PE was 0.6% after THA, 1.47% after TKA and 1.2% after UKA. The 90-day mortality was 0.39% after THA and 0.44% after TKA. No deaths occurred after UKA. The main causes of death were ischaemic heart disease and respiratory failure. PE was responsible for only 18% of deaths. There was a decline in 90-day mortality, from 0.64% between 2002 and 2007, to 0.21% between 2008 and 2013 after THA, and from 0.47% to 0.39% after TKA for the corresponding period. The standardised mortality ratio (SMR) declined from 86.5 (confidence interval (CI) 63.0 to 137.7) to 39.7 (CI 31.2 to 54.3) p = 0.024. The incidence of proximal DVT was 0.3%.
  
  
  CONCLUSIONS
  With individualised risk assessment and as part of a multimodal approach, Aspirin is safe to use as the main thromboprophylactic agent in primary arthroplasty. It is not associated with an increased incidence of symptomatic DVT, PE or death.
authors.affiliation: Musgrave Park Hospital, Stockmans Lane, Belfast, BT9 7JB, UK.
authors.forename: L
authors.initials: L
authors.lastname: Ogonda
authors.affiliation: Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.affiliation: Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK.
authors.forename: E
authors.initials: E
authors.lastname: Doran
authors.affiliation: Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK.
authors.forename: J
authors.initials: J
authors.lastname: Dennison
authors.affiliation: Queens University, 97 Lisburn Road, Belfast, BT9 7BL, UK.
authors.forename: M
authors.initials: M
authors.lastname: Stevenson
authors.affiliation: Musgrave Park Hospital, Stockman's Lane, Belfast, BT9 7JB, UK.
authors.forename: D
authors.initials: D
authors.lastname: Beverland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000401:mortality; D001241:Aspirin / Q000627:therapeutic use*; D002423:Cause of Death; D004341:Drug Evaluation / Q000379:methods; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Aspirin; Lower limb arthroplasty; Thromboprophylaxis