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Comparison of preoperative continuation and discontinuation of aspirin in patients undergoing total hip or knee arthroplasty

  • Original Article • KNEE - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Preoperative discontinuation of aspirin (acetylsalicylic acid) can reduce bleeding risk but may increase the risk of perioperative cardiovascular events.

Materials and methods

We retrospectively assessed the impact of preoperative continuation versus discontinuation of aspirin compared with a control group in a cohort of 739 consecutive patients undergoing total hip (THA) (n = 396) or knee arthroplasty (TKA) (n = 343) at a tertiary hospital. Bleeding risk, local complications, orthopaedic outcome, and cardiac and cerebral complications were assessed.

Results

Four hundred and sixty-five patients did not receive antithrombotic or full-dose anticoagulant medication, 175 patients were taking low-dose aspirin, 99 vitamin K antagonists, clopidogrel, or a combination of these drugs. Of the patients taking aspirin, 139 discontinued and 36 continued aspirin. Blood loss and local bleeding complications were comparable in these two groups. TKA patients who continued aspirin more frequently showed marked knee swelling after 1 week than those discontinuing aspirin (35.1 vs. 81.3 %; p = 0.001). However, orthopaedic outcome did not differ significantly between the two groups. There was a trend towards an increased risk of cardiac complications in patients who discontinued aspirin (6.5 vs. 0.0 %; p = 0.107).

Conclusions

Continuation or discontinuation of aspirin did not show a statistically significant difference in the risk of relevant perioperative bleeding complications in our study. Continuation of aspirin was associated with a transitory increase in knee swelling, but had no effect on orthopaedic outcome. Continuation of aspirin may be associated with a favourable perioperative cardiac outcome. Our data support perioperative continuation of aspirin intake in patients undergoing THA or TKA.

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Acknowledgments

We thank Miodrag Filipovic, Department of Anaesthesia, Kantonsspital St. Gallen, Switzerland, for his input and providing his expertise that greatly assisted this work.

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Author notes

    Authors and Affiliations

    1. Department of Handsurgery, Inselspital Bern, Freiburgstrasse 4, 3010, Bern, Switzerland

      Rahel Meier

    2. Departement of Internal Medicine, Kantonsspital Glarus, Burgstrasse 99, 8750, Glarus, Switzerland

      Regula Marthy

    3. Department of Medicine and Cardiology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria

      Christoph H. Saely

    4. Department of Orthopaedics and Traumatology, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia, 6000, Australia

      Markus S. Kuster

    5. Department of Orthopaedics and Tramatology, Kantonsspital St. Gallen, Rorschacherstrass 95, 9007, St. Gallen, Switzerland

      Karlmeinrad Giesinger

    6. Department of Cardiology, Kantonsspital St. Gallen, Rorschachstrasse 95, 9007, St. Gallen, Switzerland

      Hans Rickli

    Authors
    1. Rahel Meier
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    2. Regula Marthy
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    Correspondence to Rahel Meier or Regula Marthy.

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    Conflict of interest

    Author MK reports grants and personal fees from Zimmer Pty, Ltd, personal fees from Springer Editor, outside the submitted work. All other authors declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Patient data were analysed retrospectively and anonymized according to the requirements of the local ethics committee (canton of St. Gallen) that waved the study.

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    Rahel Meier and Regula Marthy have contributed equally to this work.

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    Meier, R., Marthy, R., Saely, C.H. et al. Comparison of preoperative continuation and discontinuation of aspirin in patients undergoing total hip or knee arthroplasty. Eur J Orthop Surg Traumatol 26, 921–928 (2016). https://doi.org/10.1007/s00590-016-1830-7

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    • DOI: https://doi.org/10.1007/s00590-016-1830-7

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