CC BY 4.0 · Surg J (N Y) 2017; 03(04): e191-e196
DOI: 10.1055/s-0037-1615817
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Systematic Review on the Use of Aspirin in the Prevention of Deep Vein Thrombosis in Major Elective Lower Limb Orthopedic Surgery: An Update from the Past 3 Years

Dylan A. Mistry
1   South Wales Orthopaedic Research Network, Cardiff University, Welshbone, Cardiff, United Kingdom
,
Amit Chandratreya
1   South Wales Orthopaedic Research Network, Cardiff University, Welshbone, Cardiff, United Kingdom
4   Princess of Wales Hospital, Abertawe Bro Morgannwg University Health Board, Bridgend, United Kingdom
,
Paul Y. F. Lee
2   Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, Lincoln, United Kingdom
3   Department of Trauma and Orthopaedic, LEO Institute, Grantham, United Kingdom
› Institutsangaben
Weitere Informationen

Publikationsverlauf

02. November 2017

27. November 2017

Publikationsdatum:
29. Dezember 2017 (online)

Abstract

Introduction Currently there are no consensuses in the national guidance on thromboprophylaxis following major elective lower limb surgery. Emerging clinical evidence suggests that aspirin could be just as effective as anticoagulants with a lower cost. The aim of this study was to provide an update based on literature of the past 3 years for the use of aspirin as thromboprophylaxis after knee and hip arthroplasty.

Materials and Methods MEDLINE/EMBASE search was performed with appropriate terms for original articles from 2014 to 2017.

Results Eight articles were found. Five articles concluded that aspirin was an effective prophylactic. The collation of results on the deep vein thrombosis rate involved 43,012 patients who were prescribed aspirin, of which 283 (0.66%) suffered from symptomatic deep vein thromboses. Aspirin was noted for its good side effect profile and cost effectiveness. It was noted that anticoagulants had a higher rate of complications, including bleeding and wound-oozing.

Conclusion Aspirin is an effective and safe prophylactic against deep vein thrombosis following major elective lower limb arthroplasty surgery.

 
  • References

  • 1 American Academy of Orthopaedic S. Preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty: evidence-based guideline and evidence report. In:2011. https://www.aaos.org/research/guidelines/vte/vte_summary_of_recs.pdf . Accessed December 18, 2017
  • 2 Falck-Ytter Y, Francis CW, Johanson NA. , et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl) e278S-e325S
  • 3 McKenna R, Bachmann F, Kaushal SP, Galante JO. Thromboembolic disease in patients undergoing total knee replacement. J Bone Joint Surg Am 1976; 58 (07) 928-932
  • 4 Paffrath T, Wafaisade A, Lefering R. , et al; Trauma Registry of DGU. Venous thromboembolism after severe trauma: incidence, risk factors and outcome. Injury 2010; 41 (01) 97-101
  • 5 MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm 2006; 63 (20) (Suppl. 06) S5-S15
  • 6 Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?. J R Soc Med 1989; 82 (04) 203-205
  • 7 Lindblad B, Eriksson A, Bergqvist D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 1991; 78 (07) 849-852
  • 8 National Institute for Clinical Excellence. Venous thromboembolism: reducing the risk for patients in hospital. January 2010. https://www.nice.org.uk/guidance/cg92 . Accessed December 18, 2017
  • 9 Cohen AT, Imfeld S, Markham J, Granziera S. The use of aspirin for primary and secondary prevention in venous thromboembolism and other cardiovascular disorders. Thromb Res 2015; 135 (02) 217-225
  • 10 Mekaj YH, Daci FT, Mekaj AY. New insights into the mechanisms of action of aspirin and its use in the prevention and treatment of arterial and venous thromboembolism. Ther Clin Risk Manag 2015; 11: 1449-1456
  • 11 Dundon JM, Trimba R, Bree KJ, Woods CJ, Laughlin RT. Recommendations for perioperative management of patients on existing anticoagulation therapy. JBJS Rev 2015; 3 (09) 01874474-201509000-00002
  • 12 Miller S, Nitzki-George D, Caprini JA. Balancing the risk of complications in foot and ankle surgical patients taking antithrombotic medication. Foot Ankle Spec 2014; 7 (06) 507-514
  • 13 Drescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ. Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med 2014; 9 (09) 579-585
  • 14 Sahebally SM, Healy D, Walsh SR. Aspirin in the primary prophylaxis of venous thromboembolism in surgical patients. Surgeon 2015; 13 (06) 348-358
  • 15 Raphael IJ, Tischler EH, Huang R, Rothman RH, Hozack WJ, Parvizi J. Aspirin: an alternative for pulmonary embolism prophylaxis after arthroplasty?. Clin Orthop Relat Res 2014; 472 (02) 482-488
  • 16 Jiang Y, Du H, Liu J, Zhou Y. Aspirin combined with mechanical measures to prevent venous thromboembolism after total knee arthroplasty: a randomized controlled trial. Chin Med J (Engl) 2014; 127 (12) 2201-2205
  • 17 Zou Y, Tian S, Wang Y, Sun K. Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty. Blood Coagul Fibrinolysis 2014; 25 (07) 660-664
  • 18 Na YG, Fang R, Kim YH, Cho KJ, Kim TK. Clinical performance of the 1st American Academy of Orthopaedic Surgeons clinical guideline on prevention of symptomatic pulmonary embolism after total knee arthroplasty in Korean patients. J Korean Med Sci 2015; 30 (12) 1865-1873
  • 19 Asopa V, Cobain W, Martin D, Keene G, Bauze A. Staged venous thromboemolic events prophylaxis with low-molecular-weight heparin followed by aspirin is safe and effective after arthroplasty. ANZ J Surg 2015; 85 (09) 652-657
  • 20 Pow RE, Vale PR. Thromboprophylaxis in patients undergoing total hip and knee arthroplasty: a review of current practices in an Australian teaching hospital. Intern Med J 2015; 45 (03) 293-299
  • 21 Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients. Bone Joint J 2016; 98-B (03) 341-348
  • 22 Yhim HY, Lee J, Lee JY, Lee JO, Bang SM. Pharmacological thromboprophylaxis and its impact on venous thromboembolism following total knee and hip arthroplasty in Korea: a nationwide population-based study. PLoS One 2017; 12 (05) e0178214
  • 23 Hovens MM, Snoep JD, Tamsma JT, Huisman MV. Aspirin in the prevention and treatment of venous thromboembolism. J Thromb Haemost 2006; 4 (07) 1470-1475
  • 24 Shah SS, Satin AM, Mullen JR, Merwin S, Goldin M, Sgaglione NA. Impact of recent guideline changes on aspirin prescribing after knee arthroplasty. J Orthop Surg 2016; 11 (01) 123
  • 25 Stein PD, Kayali F, Olson RE, Milford CE. Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census. Am J Med 2004; 116 (07) 435-442
  • 26 Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol 2000; 85 (11) 1334-1337
  • 27 Kim YH, Yoo JH, Kim JS. Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplasty 2007; 22 (07) 974-980
  • 28 Sachs RA, Smith JH, Kuney M, Paxton L. Does anticoagulation do more harm than good? A comparison of patients treated without prophylaxis and patients treated with low-dose warfarin after total knee arthroplasty. J Arthroplasty 2003; 18 (04) 389-395
  • 29 Fitzgerald Jr RH, Spiro TE, Trowbridge AA. , et al; Enoxaparin Clinical Trial Group. Prevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin. J Bone Joint Surg Am 2001; 83-A (06) 900-906