Main Article Content
Background: Thromboembolic disease is a common complication among patients undergoing total hip and knee arthroplasty. There are a large number of clinical trials demonstrating the efficacy of aspirin and enoxaparin in preventing pulmonary emboli and deep venous thrombosis. This study aimed to investigate the preventive role of aspirin and enoxaparin after knee arthroplasty (TKA).
Methods: In this retrospective study, 160 patients undergoing knee arthroplasty at Imam Hossein Hospital, Tehran, Iran between January 2010 and February 2012 were studied. Patients were divided into treatment groups receiving enoxaparin and aspirin and were evaluated within 28 days after surgery. After examining demographic factors including age and sex, variables such as DVT, pulmonary embolus, infection, transfusion RBCs and mortality were evaluated.
Results: A total thrombosis rate of 0.0125% (one deep venous thrombosis) was observed. The two groups were not significantly different in the number of patients with complications such as DVT, pulmonary embolism, infection, average number of packed RBCs, and mortality.
Conclusion: We believe that course aspirin is as effective and safe as enoxaparin for thromboprophylaxis.
White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Current Opinion Pulmonary Med 2002;8(5):365-71.
Piovella F, Wang CJ, Lu H, Lee K, Lee L, Lee W, et al. Deep‐vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thrombosis Haemostasis. 2005;3(12): 2664-70.
Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. New England J Med 2018;378(8):699-707.
Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Oral Rivaroxaban Compared with Subcutaneous Enoxaparin for Extended Thromboprophylaxis after Total Hip Arthroplasty: The RECORD1 Trial. Am Soc Hematology; 2007.
Huang Q, Xing Sx, Zeng Y, Si Hb, Zhou Zk, Shen B. Comparison of the Efficacy and Safety of Aspirin and Rivaroxaban Following Enoxaparin Treatment for Prevention of Venous Thromboembolism after Hip Fracture Surgery. Orthopaedic surgery. 2019;11(5):886-94.
Skedgel C, Goeree R, Pleasance S, Thompson K, O'brien B, Anderson D. The cost-effectiveness of extended-duration antithrombotic prophylaxis after total hip arthroplasty. JBJS. 2007;89(4):819- 28.
Huo MH, Stuckey R. Thromboembolism after total hip arthroplasty. Current Opinion Orthopaedics. 2005;16(1):25-8.
Spiro TE, Friedman RJ, Whitsett TL, Johnson GJ, Gardiner GA, Landon GC, et al. Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. JBJS. 2001;83(3):336.
Kozek-Langenecker S, Fenger-Eriksen C, Thienpont E, Barauskas G. European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the elderly. European J Anaesthesiol (EJA). 2018;35(2):116-22.
Bozic KJ, Vail TP, Pekow PS, Maselli JH, Lindenauer PK, Auerbach AD. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthr. 2010;25(7): 1053-60.
Prevention PE. Trial Collaborative Group. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial Lancet. 2000;355(9212):1295-302.
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(6):381S-453S.
McKenna R, Galante J, Bachmann F, Wallace D, Kaushal P, Meredith P. Prevention of venous thromboembolism after total knee replacement by high-dose aspirin or intermittent calf and thigh compression. Br Med J. 1980;280(6213): 514-7.
Lachiewicz PF, Soileau ES. Mechanical calf compression and aspirin prophylaxis for total knee arthroplasty. Clinical Orthopaedics Related Res. 2007;464:61-4.
Moningi S, Patki A, Padhy N, Ramachandran G. Enhanced recovery after surgery: An anesthesiologist's perspective. J Anaesthesiol Clin Pharmacol. 2019;35(Suppl 1):S5.
Dorr LD, Gendelman V, Maheshwari AV, Boutary M, Wan Z, Long WT. Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk assessment. JBJS. 2007;89(12):2648-57.
Sugano N, Miki H, Nakamura N, Aihara M, Yamamoto K, Ohzono K. Clinical efficacy of mechanical thromboprophylaxis without anticoagulant drugs for elective hip surgery in an Asian population. The Journal of arthroplasty. 2009;24(8):1254- 7.
Colwell Jr CW, Froimson MI, Mont MA, Ritter MA, Trousdale RT, Buehler KC, et al. Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. JBJS. 2010;92(3):527-35.
Oster G, Ollendorf DA, Vera-Llonch M, Hagiwara M, Berger A, Edelsberg J. Economic consequences of venous thromboembolism following major orthopedic surgery. Annals Pharmaco-therapy. 2004;38(3):377-82.
Rachidi S, Aldin ES, Greenberg C, Sachs B, Streiff M, Zeidan AM. The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery. Expert Revi Hematol. 2013;6(6): 677-95.
Haas SB, Barrack RL, Westrich G, Lachiewicz PF. Venous thromboembolic disease after total hip and knee arthroplasty. JBJS. 2008;90(12):2764- 80.
Bratzler DW. Development of national performance measures on the prevention and treatment of venous thromboem bolism. J Thrombosis Thrombolysis. 2010; 29(2):148-54.
Novicoff WM, Brown TE, Cui Q, Mihalko WM, Slone HS, Saleh KJ. Mandated venous thromboembolism prophylaxis: possible adverse outcomes. J Arthroplasty. 2008;23(6):15-9.
Eikelboom JW, Quinlan DJ, Douketis JD. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: A meta-analysis of the randomised trials. The Lancet. 2001; 358(9275):9-15.
McAndrew CM, Fitzgerald SJ, Kraay MJ, Goldberg VM. Incidence of postthrombotic syndrome in patients undergoing primary total knee arthroplasty for osteoarthritis. Clin Orthopaedics Related Res 2010; 468(1):178-81.
Fisher W, Agnelli G, George D, Kakkar A, Lassen M, Mismetti P, et al. Extended venous thromboembolism prophylaxis in patients undergoing hip fracture surgery–The SAVE-HIP3 study. Bone Joint J. 2013;95(4):459-66.
Eriksson BI, Lassen MR. Duration of prophylaxis against venous thromboem-bolism with fondaparinux after hip fracture surgery: A multicenter, randomized, placebo-controlled, double-blind study. Archives Internal Med. 2003;163(11): 1337-42.
Larsen K, Hansen TB, Thomsen PB, Christiansen T, Søballe K. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. JBJS. 2009;91(4):761-72.
Dhupar S, Iorio R, Healy WL, Dhimitri K. A comparison of discharge and two-week duplex ultrasound screening protocols for deep venous thrombosis detection following primary total joint arthroplasty. JBJS. 2006;88(11):2380-5.
Surgeons AAoO. American Academy of Orthopaedic Surgeons clinical guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.
http://www aaos org/Research/guidelines/PE_guideline pdf. 2007.