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Aspirin compared to enoxaparin or rivaroxaban for thromboprophylaxis following hip and knee replacement

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Abstract

Background The risk of venous thromboembolism following major orthopaedic surgery is among the highest for all surgical specialties. Our hospital guidelines for thromboprophylaxis following elective primary total hip or knee replacement are based on American College of Chest Physicians guidance. The most recent change to local guidelines was the introduction of the extended aspirin regimen as standard thromboprophylaxis. Objective To establish the appropriateness of this regimen by comparing venous thromboembolism rates in patients receiving extended aspirin to previous regimens. Setting The largest dedicated orthopaedic hospital in Ireland. Methods This was a retrospective cohort study. Data were collected from patient record software. All eligible patients undergoing primary total hip or knee replacement between 1st January 2010 and 30th June 2016 were included. Main outcome measure Venous thromboembolism up to 6 months post-operatively. Results Of the 6548 participants (55.3% female, mean age 65.4 years (± 11.8 years, 55.8% underwent total hip replacement), venous thromboembolism occurred in 65 (0.99%). Venous thromboembolism rate in both the inpatient enoxaparin group (n = 961) and extended aspirin group (n = 3460) was 1.04% and was 0.66% in the modified rivaroxaban group (n = 1212). Non-inferiority analysis showed the extended aspirin regimen to be equivalent to the modified rivaroxaban regimen. History of venous thromboembolism was the only significant demographic risk factor for post-operative venous thromboembolism (0.87% vs. 3.54%, p  = 0.0002). Conclusion In daily clinical practice, extended aspirin regimen is at least as effective as modified rivaroxaban for preventing clinically important venous thromboembolism among patients undergoing hip or knee arthroplasty who are discharged from the hospital without complications. Aspirin can be considered a safe and effective agent in the prevention of venous thromboembolism after total hip or total knee replacement.

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Acknowledgements

The authors would like to thank all the staff in Cappagh National Orthopaedic Hospital who contributed to the study, particularly the Department of Anaesthetics the Department of Orthopaedic Surgery, and the staff in the Pharmacy Department, Pre-Assessment Clinic and Joint Register.

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No funding was received for this study.

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Authors and Affiliations

  1. Pharmacy Department, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland

    Sadhbh Ní Cheallaigh, Eimear Kehoe & Charles O’Connell

  2. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland

    Aoife Fleming & Laura J. Sahm

  3. HRB Clinical Research Facility Cork, School of Public Health, University College Cork, Cork, Ireland

    Darren Dahly

  4. RCSI Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland

    John M. O’Byrne

  5. Department of Anaesthetics, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland

    Brid McGrath

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  1. Sadhbh Ní Cheallaigh
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Ní Cheallaigh, S., Fleming, A., Dahly, D. et al. Aspirin compared to enoxaparin or rivaroxaban for thromboprophylaxis following hip and knee replacement. Int J Clin Pharm 42, 853–860 (2020). https://doi.org/10.1007/s11096-020-01032-1

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