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Pulmonary Vascular Disease |

Aspirin Versus Anticoagulation for the Prevention of Venous Thromboembolism in Orthopedic Patients After Lower Extremity Reconstructive Surgery — A Systematic Review

Alexandra Lee, MS; Robin Larson, MD; Daniel Morrison, MD; Wesley Chiang, BS; Frank Drescher*, MD
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Veterans Affairs Medical Center, White River Junction, VT


Chest. 2012;142(4_MeetingAbstracts):832A. doi:10.1378/chest.1374115
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Abstract

SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To assess bleeding complications, venous thromboembolism (VTE) event rates, and mortality when comparing aspirin to anticoagulation in orthopedic patients after lower extremity reconstructive surgery.

METHODS: We searched MEDLINE (1966-September 2011), CINAHL (1974-October 2011) and the Cochrane Controlled Clinical Trials Register Database (1966-October 2011), in addition to manual review of meeting abstracts and reference lists. Randomized controlled studies comparing aspirin to heparin, low-molecular weight heparin or Vitamin-K antagonists for prevention of VTE in orthopedic patients after hip arthroplasty, knee arthroplasty or hip fracture repair were included. Studies in oncologic patients were excluded whereas pneumatic compression devices in both study arms were allowed as a co-intervention.

RESULTS: We identified 253 studies by initial search. Data were available from 8 randomized controlled trials (n=1408 participants). Compared with anticoagulants, aspirin was associated with significantly lower overall bleeding rates (RR 0.52, 95% CI 0.31 to 0.86). Overall deep vein thrombosis rates were not different between aspirin and anticoagulation (RR 1.15, 95% CI 0.49 to 2.05). Subgroup analyses were performed to determine the rate of proximal DVT for patients undergoing hip fracture surgery (RR 1.60, 95% CI 0.80-3.20) versus hip/knee arthroplasty (RR 1.00, 95% CI 0.49-2.05). Event rates of pulmonary embolism slightly favored anticoagulation (RR 1.73, 95% CI 0.69 to 4.34), but this was not statistically significant. Data was inadequate to assess for differences in mortality.

CONCLUSIONS: The included studies suggest that aspirin may be associated with lower bleeding rates than anticoagulants following lower extremity reconstructive surgery. Aspirin should be used with caution in patients undergoing orthopedic surgery after hip fracture, however, further research should be conducted to determine if aspirin is safe and efficacious in preventing VTE for patients undergoing hip or knee arthroplasty.

CLINICAL IMPLICATIONS: Administration of anticoagulants is standard of care for preventing VTE following lower extremity reconstructive orthopedic surgery; however, increased bleeding at the surgical site is a concern. While use of aspirin is supported by national guidelines, uncertainty remains as to whether the improved safety is offset by decreased efficacy.

DISCLOSURE: The following authors have nothing to disclose: Alexandra Lee, Robin Larson, Daniel Morrison, Wesley Chiang, Frank Drescher

No Product/Research Disclosure Information

Veterans Affairs Medical Center, White River Junction, VT

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