International Orthopaedics

, Volume 36, Issue 10, pp 1995–2002 | Cite as

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

  • Ettore Vulcano
  • Mark Gesell
  • Amanda Esposito
  • Yan Ma
  • Stavros G. Memtsoudis
  • Alejandro Gonzalez Della Valle
Original Paper



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.


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.


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 %.


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



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.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ettore Vulcano
    • 1
  • Mark Gesell
    • 1
  • Amanda Esposito
    • 2
  • Yan Ma
    • 3
  • Stavros G. Memtsoudis
    • 4
  • Alejandro Gonzalez Della Valle
    • 1
  1. 1.Department of Orthopaedic SurgeryHospital for Special Surgery and Weill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Weill Medical College of Cornell UniversityNew YorkUSA
  3. 3.Department of BiostatisticsHospital for Special Surgery and Weill Medical College of Cornell UniversityNew YorkUSA
  4. 4.Department of AnesthesiologyHospital for Special Surgery and Weill Medical College of Cornell UniversityNew YorkUSA

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