Skip to main content

Advertisement

SpringerLink
Log in

Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Multimodal thromboprophylaxis includes preoperative thromboembolic risk stratification and autologous blood donation, surgery performed under regional anaesthesia, postoperative rapid mobilisation, use of pneumatic compression devices and chemoprophylaxis tailored to the patient’s individual risk. We determined the 90-day rate of venous thromboembolism (VTE), other complications and mortality in patients who underwent primary elective hip and knee replacement surgery with multimodal thromboprophylaxis.

Methods

A total of 1,568 consecutive patients undergoing hip and knee replacement surgery received multimodal thromboprophylaxis: 1,115 received aspirin, 426 received warfarin and 27 patients received low molecular weight heparin and warfarin with or without a vena cava filter.

Results

The rate of VTE, pulmonary embolism, proximal deep vein thrombosis (DVT) and distal DVT was 1.2, 0.36, 0.45 and 0.36 %, respectively, in patients who received aspirin. The rates in those who received warfarin were 1.4, 0.9, 0.47 and 0.47 %, respectively. The overall 90-day mortality rate was 0.2 %.

Conclusions

Multimodal thromboprophylaxis in which aspirin is administered to low-risk patients is safe and effective following primary total joint replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Freedman KB, Brookenthal KR, Fitzgerald RH Jr, Williams S, Lonner JH (2000) A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg 82:929–938

    PubMed  Google Scholar 

  2. Falck-Ytter Y, Francis CW, Johanson NA et al (2012) 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 141(2 Suppl):e278S–e325S

    Article  PubMed  CAS  Google Scholar 

  3. Treasure T, Chong LY, Sharpin C, Wonderling D, Head K, Hill J (2010) Developing guidelines for venous thromboembolism for The National Institute for Clinical Excellence: involvement of the orthopaedic surgical panel. J Bone Joint Surg Br 92(5):611–616

    Article  PubMed  CAS  Google Scholar 

  4. http://www.cms.hhs.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp

  5. Butt AJ, McCarthy T, Kelly IP, Glynn T, McCoy G (2005) Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement. J Bone Joint Surg Br 87:1465–1467

    Article  PubMed  CAS  Google Scholar 

  6. Callaghan JJ, Dorr LD, Engh GA, Hanssen AD, Healy WL, Lachiewicz PF, Lonner JH, Lotke PA, Ranawat CS, Ritter MA, Salvati EA, Sculco TP, Thornhill TS, American College of Chest Physicians (2005) Prophylaxis for thromboembolic disease: recommendations from the American College of Chest Physicians–are they appropriate for orthopaedic surgery? J Arthroplasty 20:273–274

    Article  PubMed  Google Scholar 

  7. Salvati EA, Sharrock NE, Westrich G, Potter HG, Gonzalez Della Valle A, Sculco TP (2007) The 2007 ABJS Nicolas Andry Award: three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res 459:246–254

    Article  PubMed  Google Scholar 

  8. Beksaç B, González Della Valle A, Anderson J, Sharrock NE, Sculco TP, Salvati EA (2007) Symptomatic thromboembolism after one-stage bilateral THA with a multimodal prophylaxis protocol. Clin Orthop Relat Res 463:114–119

    PubMed  Google Scholar 

  9. Beksaç B, González Della Valle A, Salvati EA (2006) Thromboembolic disease after total hip arthroplasty: who is at risk? Clin Orthop Relat Res 453:211–224

    Article  PubMed  Google Scholar 

  10. Sharrock NE, Go G, Harpel PC, Ranawat CS, Sculco TP, Salvati EA (1995) The John Charnley Award. Thrombogenesis during total hip arthroplasty. Clin Orthop Relat Res 319:16–27

    PubMed  Google Scholar 

  11. Westrich GH, Farrell C, Bono JV, Ranawat CS, Salvati EA, Sculco TP (1999) The incidence of venous thromboembolism after total hip arthroplasty: a specific hypotensive epidural anesthesia protocol. J Arthroplasty 14(4):456–463

    Article  PubMed  CAS  Google Scholar 

  12. Bae H, Westrich G, Sculco TP, Salvati EA, Reich LM (2001) The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty. J Bone Joint Surg Br 83(5):676–679

    Article  PubMed  CAS  Google Scholar 

  13. González Della Valle A, Serota A, Go G, Sorriaux G, Sculco TP, Sharrock NE, Salvati EA (2006) Venous thromboembolism is rare with a multimodal prophylaxis protocol after total hip arthroplasty. Clin Orthop Relat Res 444:146–153

    Article  PubMed  Google Scholar 

  14. Gesell M, Gonzalez Della Valle A, Haas S, Salvati E (2011) Safety and efficacy of multimodal thromboprophylaxis following elective total knee arthroplasty. A comparative study with selective versus routine use of coumadin for chemoprophylaxis. American Association of Hip and Knee Surgeons, 21st Annual Meeting, poster presentation

  15. Memtsoudis SG, González Della Valle A, Besculides MC, Gaber L, Sculco TP (2008) In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res 466(11):2617-2627

    Article  PubMed  Google Scholar 

  16. Asnis PD, Gardner MJ, Ranawat A, Leitzes AH, Peterson MG, Bass AR (2007) The effectiveness of warfarin dosing from a nomogram compared with house staff dosing. J Arthroplasty 22(2):213–218

    Article  PubMed  Google Scholar 

  17. Parvizi J, Smith EB, Pulido L, Mamelak J, Morrison WB, Purtill JJ, Rothman RH (2007) The rise in the incidence of pulmonary embolus after joint arthroplasty: is modern imaging to blame? Clin Orthop Relat Res 463:107–113

    PubMed  Google Scholar 

  18. Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA (2008) Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res 466(3):714–721

    Article  PubMed  Google Scholar 

  19. Jameson SS, Charman SC, Gregg PJ, Reed MR, van der Meulen JH (2011) The effect of aspirin and low-molecular-weight heparin on venous thromboembolism after hip replacement: a non-randomised comparison from information in the National Joint Registry. J Bone Joint Surg Br 93(11):1465–1470

    Article  PubMed  CAS  Google Scholar 

  20. Auer RC, Schulman AR, Tuorto S, Gönen M, Gonsalves J, Schwartz L, Ginsberg MS, Fong Y (2009) Use of helical CT is associated with an increased incidence of postoperative pulmonary emboli in cancer patients with no change in number of fatal pulmonary emboli. J Am Coll Surg 208(5):871–878

    Article  PubMed  Google Scholar 

  21. Poultsides LA, Gonzalez Della Valle A, Memtsoudis SG, Ma Y, Roberts T, Sharrock N, Salvati E (2012) Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens. J Bone Joint Surg Br 94(1):113–121

    Article  PubMed  CAS  Google Scholar 

  22. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW, American College of Chest Physicians (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133(6 Suppl):381S–453S

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was partially funded by the generous donations of Mr. Glenn Bergenfield, The Sidney Milton and Leoma Simon Foundation, and Dr. and Mrs. Alberto Foglia.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Medical College of Cornell University, 535 East 70th Street, New York, NY, 10021, USA

    Ettore Vulcano, Mark Gesell & Alejandro Gonzalez Della Valle

  2. Weill Medical College of Cornell University, New York, NY, USA

    Amanda Esposito

  3. Department of Biostatistics, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY, USA

    Yan Ma

  4. Department of Anesthesiology, Hospital for Special Surgery and Weill Medical College of Cornell University, New York, NY, USA

    Stavros G. Memtsoudis

Authors
  1. Ettore Vulcano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Gesell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stavros G. Memtsoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alejandro Gonzalez Della Valle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alejandro Gonzalez Della Valle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vulcano, E., Gesell, M., Esposito, A. et al. Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol. International Orthopaedics (SICOT) 36, 1995–2002 (2012). https://doi.org/10.1007/s00264-012-1588-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-012-1588-4

Keywords

Search

Navigation