Comparative Retrospective Study between Aspirin and Dabigatran in the Incidence of Thromboembolic Events in Hip and Knee Arthroplasty
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Published:
Aug 19, 2021
Keywords:
Aspirin, acetylsalicylic acid, dabigatran, thromboprophylaxis, thromboembolic event, hip arthroplasty, knee arthroplasty
Main Article Content
Abstract
Objective: To analyze the incidence of out-of-hospital thromboembolic events after a primary total knee or hip replacement in the first 90 postoperative days, using acetylsalicylic acid or dabigatran as thromboprophylaxis. As a secondary objective, to evaluate the cost of antiplatelet therapy compared to anticoagulants.
Materials and Methods: A retrospective observational study was carried out in the postoperative period of primary total hip and knee replacement on the incidence of out-of-hospital thromboembolic events during the first 90 postoperative days in two groups of patients. Acetylsalicylic acid (325 mg per day) or dabigatran (150 to 220 mg per day) were used as thromboprophylaxis for 35 days.
Results: The series consisted of 224 patients aged 68.5 years (38-95 years), 44.2% male. 51.3% corresponded to total hip replacement. 64.3% continued thromboprophylaxis with dabigatran and 35.7% with aspirin. The total incidence of thromboembolic events was 1.3%. In the patients who received dabigatran it was 1.4% and in those who received aspirin, 1.3% (p = 0.9). The cost of thromboprophylaxis with aspirin 325 mg was US $ 3.6 while with dabigatran it was US $ 130 or $ 175, according to its presentation, 75 and 110 mg.
Conclusion: Aspirin as thromboprophylaxis after total hip or knee replacement in individuals at low risk of thromboembolic events has shown similar clinical outcomes as dabigatran, and a multimodal protocol based on the use of aspirin can be recommended. This improves patient adherence to antithrombotic therapy, due to the low cost of aspirin prophylaxis.
Materials and Methods: A retrospective observational study was carried out in the postoperative period of primary total hip and knee replacement on the incidence of out-of-hospital thromboembolic events during the first 90 postoperative days in two groups of patients. Acetylsalicylic acid (325 mg per day) or dabigatran (150 to 220 mg per day) were used as thromboprophylaxis for 35 days.
Results: The series consisted of 224 patients aged 68.5 years (38-95 years), 44.2% male. 51.3% corresponded to total hip replacement. 64.3% continued thromboprophylaxis with dabigatran and 35.7% with aspirin. The total incidence of thromboembolic events was 1.3%. In the patients who received dabigatran it was 1.4% and in those who received aspirin, 1.3% (p = 0.9). The cost of thromboprophylaxis with aspirin 325 mg was US $ 3.6 while with dabigatran it was US $ 130 or $ 175, according to its presentation, 75 and 110 mg.
Conclusion: Aspirin as thromboprophylaxis after total hip or knee replacement in individuals at low risk of thromboembolic events has shown similar clinical outcomes as dabigatran, and a multimodal protocol based on the use of aspirin can be recommended. This improves patient adherence to antithrombotic therapy, due to the low cost of aspirin prophylaxis.
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How to Cite
Lopreite, F. A., Dainotto, T., Gaggiotti, S., & del Sel, H. (2021). Comparative Retrospective Study between Aspirin and Dabigatran in the Incidence of Thromboembolic Events in Hip and Knee Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(4), 446-454. https://doi.org/10.15417/issn.1852-7434.2021.86.4.1303
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Clinical Research
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References
1. Azboy I, Barrack R, Thomas AM, Haddad FS, Parvizi J. Aspirin and the prevention of venous thromboembolism
following total joint arthroplasty: Commonly asked questions. Bone Joint J 2017;99B(11):1420-30.
https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0337.R2
2. Mostafavi Tabatabaee R, Rasouli MR, Maltenfort MG, Parvizi J. Cost-effective prophylaxis against venous
thromboembolism after total joint arthroplasty: warfarin versus aspirin. J Arthroplasty 2015;30(2):159-64.
https://doi.org/10.1016/j.arth.2014.08.018
3. An VVG, Phan K, Levy YD, Bruce WJM. Aspirin as thromboprophylaxis in hip and knee arthroplasty: a systematic
review and meta-analysis. J Arthroplasty 2016;31(11):2608-16. https://doi.org/10.1016/j.arth.2016.04.004
4. 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 Res 2016;11(1):123. https://doi.org/10.1186/s13018-016-0456-0
5. McHale S, Williams M, O’Mahony C, Hockings M. Should we use dabigatran or aspirin thromboprophylaxis in
total hip and knee arthroplasty? A natural experiment. J Orthop 2019;16(6):563-8. https://doi.org/10.1016/j.jor.2019.05.008
6. Lee YK, Chung CY, Koo KH, Lee KM, Ji HM, Park MS. Conflict of interest in the assessment of thromboprophylaxis after total joint arthroplasty: A systematic review. J Bone Joint Surg Am 2012;94(1):27-33.
https://doi.org/10.2106/JBJS.J.01033
7. Parvizi J, Huang R, Restrepo C, Chen AF, Austin MS, Hozack WJ, et al. Low-dose aspirin is effective
chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty a
preliminary analysis. J Bone Joint Surg Am 2017;99(2):91-8. https://doi.org/10.2106/JBJS.16.00147
8. Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary
lower limb arthroplasty. Bone Joint J 2016;98B(3):341-8. https://doi.org/10.1302/0301-620X.98B3.36511
9. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients
undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011;19(12):768-76.
https://doi.org/10.5435/00124635-201112000-00008
10. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, 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.
https://doi.org/10.1378/chest.11-2404
11. Rodgers A, MacMahon S, Collins R, Prentice C. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000;355(9212):1295-302. PMID: 10776741
12. Lussana F, Squizzato A, Permunian Tamborini E, Cattaneo M. A systematic review on the effect of aspirin in the prevention of post-operative arterial thrombosis in patients undergoing total hip and total knee arthroplasty. Thromb Res 2014;99-B(11):1420-30. PMID: 29092979
13. Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. RE NOVATE (Dabigatran v
warfarin hip). Lancet 2007;370(9591):949-56. https://doi.org/10.1016/S0140-6736(07)61445-7
14. Jenny JY, Pabinger I, Samama CM. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018;35(2):123-9. https://doi.org/ 10.1097/EJA.0000000000000728
15. NICE Guidance. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Natl Inst Heal Care Excell 2018. Disponible en: https://www.nice.org.uk/guidance/ng89
16. Feldstein MJ, Low SL, Chen AF, Woodward LA, Hozack WJ. A Comparison of two dosing regimens of ASA
following total hip and knee arthroplasties. J Arthroplasty 2017;32(9):S157-61. https://doi.org/10.1016/j.arth.2017.01.009
17. 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 Arthroplasty 2010;25(7):1053-60.
https://doi.org/10.1016/j.arth.2009.06.021
18. Parvizi J, Ghanem E, Joshi A, Sharkey PF, Hozack WJ, Rothman RH. Does “excessive” anticoagulation predispose to periprosthetic infection? J Arthroplasty 2007;22(6 Suppl 2):24-8. https://doi.org/ 10.1016/j.arth.2007.03.007
19. Aquilina AL, Brunton LR, Whitehouse MR, Sullivan N, Blom AW. Direct thrombin inhibitor (DTI) vs. aspirin in
primary total hip and knee replacement using wound ooze as the primary outcome measure. A prospective cohort study. Hip Int 2012;22(1):22-7. PMID: 22362503
20. Lindquist DE, Stewart DW, Brewster A, Waldroup C, Odle BL, Burchette JE, et al. Comparison of postoperative
bleeding in total hip and knee arthroplasty patients receiving rivaroxaban, enoxaparin, or aspirin for
thromboprophylaxis. Clin Appl Thromb 2018;24(8):1315-21. https://doi.org/10.1177/1076029618772337
21. Wilson DGG, Poole WEC, Chauhan SK, Rogers BA. Systematic review of aspirin for thromboprophylaxis in
modern elective total hip and knee arthroplasty. Bone Joint J 2016;98-B(8):1056-61. https://doi.org/10.1302/0301-620X.98B8.36957
22. Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, et al. 90-day mortality after 409 096
total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: A retrospective
analysis. Lancet 2013;382(9898):1097-104. https://doi.org/10.1016/S0140-6736(13)61749-3
23. Singh JA, Lewallen DG. Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J Arthroplasty 2012;27(8):1417-22. https://doi.org/ 10.1016/j.arth.2012.03.008
24. Quah C, Bayley E, Bhamber N, Howard P. Fatal pulmonary embolism following elective total knee replacement using aspirin in multi-modal prophylaxis — A 12 year study. Knee 2017;24(5):1187-90.
https://doi.org/10.1016/j.knee.2017.05.021
25. Gutowski CJ, Zmistowski BM, Lonner JH, Purtill JJ, Parvizi J. Direct costs of aspirin versus warfarin for venous
thromboembolism prophylaxis after total knee or hip arthroplasty. J Arthroplasty 2015;30(9 Suppl):36-8.
https://doi.org/10.1016/j.arth.2015.04.048
following total joint arthroplasty: Commonly asked questions. Bone Joint J 2017;99B(11):1420-30.
https://doi.org/10.1302/0301-620X.99B11.BJJ-2017-0337.R2
2. Mostafavi Tabatabaee R, Rasouli MR, Maltenfort MG, Parvizi J. Cost-effective prophylaxis against venous
thromboembolism after total joint arthroplasty: warfarin versus aspirin. J Arthroplasty 2015;30(2):159-64.
https://doi.org/10.1016/j.arth.2014.08.018
3. An VVG, Phan K, Levy YD, Bruce WJM. Aspirin as thromboprophylaxis in hip and knee arthroplasty: a systematic
review and meta-analysis. J Arthroplasty 2016;31(11):2608-16. https://doi.org/10.1016/j.arth.2016.04.004
4. 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 Res 2016;11(1):123. https://doi.org/10.1186/s13018-016-0456-0
5. McHale S, Williams M, O’Mahony C, Hockings M. Should we use dabigatran or aspirin thromboprophylaxis in
total hip and knee arthroplasty? A natural experiment. J Orthop 2019;16(6):563-8. https://doi.org/10.1016/j.jor.2019.05.008
6. Lee YK, Chung CY, Koo KH, Lee KM, Ji HM, Park MS. Conflict of interest in the assessment of thromboprophylaxis after total joint arthroplasty: A systematic review. J Bone Joint Surg Am 2012;94(1):27-33.
https://doi.org/10.2106/JBJS.J.01033
7. Parvizi J, Huang R, Restrepo C, Chen AF, Austin MS, Hozack WJ, et al. Low-dose aspirin is effective
chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty a
preliminary analysis. J Bone Joint Surg Am 2017;99(2):91-8. https://doi.org/10.2106/JBJS.16.00147
8. Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary
lower limb arthroplasty. Bone Joint J 2016;98B(3):341-8. https://doi.org/10.1302/0301-620X.98B3.36511
9. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients
undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 2011;19(12):768-76.
https://doi.org/10.5435/00124635-201112000-00008
10. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, 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.
https://doi.org/10.1378/chest.11-2404
11. Rodgers A, MacMahon S, Collins R, Prentice C. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000;355(9212):1295-302. PMID: 10776741
12. Lussana F, Squizzato A, Permunian Tamborini E, Cattaneo M. A systematic review on the effect of aspirin in the prevention of post-operative arterial thrombosis in patients undergoing total hip and total knee arthroplasty. Thromb Res 2014;99-B(11):1420-30. PMID: 29092979
13. Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. RE NOVATE (Dabigatran v
warfarin hip). Lancet 2007;370(9591):949-56. https://doi.org/10.1016/S0140-6736(07)61445-7
14. Jenny JY, Pabinger I, Samama CM. European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 2018;35(2):123-9. https://doi.org/ 10.1097/EJA.0000000000000728
15. NICE Guidance. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Natl Inst Heal Care Excell 2018. Disponible en: https://www.nice.org.uk/guidance/ng89
16. Feldstein MJ, Low SL, Chen AF, Woodward LA, Hozack WJ. A Comparison of two dosing regimens of ASA
following total hip and knee arthroplasties. J Arthroplasty 2017;32(9):S157-61. https://doi.org/10.1016/j.arth.2017.01.009
17. 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 Arthroplasty 2010;25(7):1053-60.
https://doi.org/10.1016/j.arth.2009.06.021
18. Parvizi J, Ghanem E, Joshi A, Sharkey PF, Hozack WJ, Rothman RH. Does “excessive” anticoagulation predispose to periprosthetic infection? J Arthroplasty 2007;22(6 Suppl 2):24-8. https://doi.org/ 10.1016/j.arth.2007.03.007
19. Aquilina AL, Brunton LR, Whitehouse MR, Sullivan N, Blom AW. Direct thrombin inhibitor (DTI) vs. aspirin in
primary total hip and knee replacement using wound ooze as the primary outcome measure. A prospective cohort study. Hip Int 2012;22(1):22-7. PMID: 22362503
20. Lindquist DE, Stewart DW, Brewster A, Waldroup C, Odle BL, Burchette JE, et al. Comparison of postoperative
bleeding in total hip and knee arthroplasty patients receiving rivaroxaban, enoxaparin, or aspirin for
thromboprophylaxis. Clin Appl Thromb 2018;24(8):1315-21. https://doi.org/10.1177/1076029618772337
21. Wilson DGG, Poole WEC, Chauhan SK, Rogers BA. Systematic review of aspirin for thromboprophylaxis in
modern elective total hip and knee arthroplasty. Bone Joint J 2016;98-B(8):1056-61. https://doi.org/10.1302/0301-620X.98B8.36957
22. Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, et al. 90-day mortality after 409 096
total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: A retrospective
analysis. Lancet 2013;382(9898):1097-104. https://doi.org/10.1016/S0140-6736(13)61749-3
23. Singh JA, Lewallen DG. Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J Arthroplasty 2012;27(8):1417-22. https://doi.org/ 10.1016/j.arth.2012.03.008
24. Quah C, Bayley E, Bhamber N, Howard P. Fatal pulmonary embolism following elective total knee replacement using aspirin in multi-modal prophylaxis — A 12 year study. Knee 2017;24(5):1187-90.
https://doi.org/10.1016/j.knee.2017.05.021
25. Gutowski CJ, Zmistowski BM, Lonner JH, Purtill JJ, Parvizi J. Direct costs of aspirin versus warfarin for venous
thromboembolism prophylaxis after total knee or hip arthroplasty. J Arthroplasty 2015;30(9 Suppl):36-8.
https://doi.org/10.1016/j.arth.2015.04.048