Comparison of preoperative continuation and discontinuation of aspirin in patients undergoing total hip or knee arthroplasty.
BACKGROUND
Preoperative discontinuation of aspirin (acetylsalicylic acid) can reduce bleeding risk but may increase the risk of perioperative cardiovascular events.


METHODS
We retrospectively assessed the impact of preoperative continuation versus discontinuation of aspirin compared with a control group in a cohort of 739 consecutive patients undergoing total hip (THA) (n = 396) or knee arthroplasty (TKA) (n = 343) at a tertiary hospital. Bleeding risk, local complications, orthopaedic outcome, and cardiac and cerebral complications were assessed.


RESULTS
Four hundred and sixty-five patients did not receive antithrombotic or full-dose anticoagulant medication, 175 patients were taking low-dose aspirin, 99 vitamin K antagonists, clopidogrel, or a combination of these drugs. Of the patients taking aspirin, 139 discontinued and 36 continued aspirin. Blood loss and local bleeding complications were comparable in these two groups. TKA patients who continued aspirin more frequently showed marked knee swelling after 1 week than those discontinuing aspirin (35.1 vs. 81.3 %; p = 0.001). However, orthopaedic outcome did not differ significantly between the two groups. There was a trend towards an increased risk of cardiac complications in patients who discontinued aspirin (6.5 vs. 0.0 %; p = 0.107).


CONCLUSIONS
Continuation or discontinuation of aspirin did not show a statistically significant difference in the risk of relevant perioperative bleeding complications in our study. Continuation of aspirin was associated with a transitory increase in knee swelling, but had no effect on orthopaedic outcome. Continuation of aspirin may be associated with a favourable perioperative cardiac outcome. Our data support perioperative continuation of aspirin intake in patients undergoing THA or TKA.
Department of Handsurgery, Inselspital Bern, Freiburgstrasse 4, 3010, Bern, Switzerland. rahel.meier@insel.ch.
Rahel
R
Meier
Departement of Internal Medicine, Kantonsspital Glarus, Burgstrasse 99, 8750, Glarus, Switzerland. regula.marthy@ksgl.ch.
Regula
R
Marthy
Department of Medicine and Cardiology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria.
Christoph H
CH
Saely
Department of Orthopaedics and Traumatology, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia.
Markus S
MS
Kuster
Department of Orthopaedics and Tramatology, Kantonsspital St. Gallen, Rorschacherstrass 95, 9007, St. Gallen, Switzerland.
Karlmeinrad
K
Giesinger
Department of Cardiology, Kantonsspital St. Gallen, Rorschachstrasse 95, 9007, St. Gallen, Switzerland.
Hans
H
Rickli
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D020379:Risk Adjustment / Q000379:methods; D013557:Switzerland; D028761:Withholding Treatment
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
Aspirin; Postoperative complications; Preoperative period; Total hip arthroplasty; Total knee arthroplasty