Aspirin for the Prophylaxis of Venous Thromboembolic Events in Orthopedic Surgery Patients: A Comparison of the AAOS and ACCP Guidelines with Review of the Evidence

Stewart, David W.; Freshour, Jessica

doi:10.1345/aph.1r331

Cited by 69 publications

(56 citation statements)

References 42 publications

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“…Aspirin is not an appropriate sole option for prevention of VTE after hip fracture 184 but can be considered as an option if part of a multimodal approach to prevention including other means such as mechanical compression devices. 185 Aspirin has not been found to have a lesser risk of bleeding complications when compared with other pharmacologic options. 185 …”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Pharmacologic Prophylaxismentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

132

121

View full text Add to dashboard Cite

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“…Among these, aspirin, the only nonanticoagulant, has been the source of greatest controversy. 4,9,10 Two previous systematic reviews comparing aspirin to anticoagulation for VTE prevention found conflicting results. 11,12 In addition, both used indirect comparisons, a method in which the intervention and comparison data come from different studies, and susceptibility to confounding is high.…”

Section: Data Extractionmentioning

confidence: 99%

Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: A systematic review and meta-analysis

et al. 2014

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BACKGROUND Hip fracture surgery and lower extremity arthroplasty are associated with increased risk of both venous thromboembolism and bleeding. The best pharmacologic strategy for reducing these opposing risks is uncertain. PURPOSE To compare venous thromboembolism (VTE) and bleeding rates in adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery. DATA SOURCES Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library through June 2013; reference lists, ClinicalTrials.gov, and scientific meeting abstracts. STUDY SELECTION Randomized trials comparing aspirin to anticoagulants for prevention of VTE following major lower extremity orthopedic surgery. DATA EXTRACTION Two reviewers independently extracted data on rates of VTE, bleeding, and mortality. DATA SYNTHESIS Of 298 studies screened, 8 trials including 1408 participants met inclusion criteria; all trials screened participants for deep venous thrombosis (DVT). Overall rates of DVT did not differ statistically between aspirin and anticoagulants (relative risk [RR]: 1.15 [95% confidence interval {CI}: 0.68–1.96]). Subgrouped by type of surgery, there was a nonsignificant trend favoring anticoagulation following hip fracture repair but not knee or hip arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80–3.20], 2 trials; arthroplasty RR: 1.00 [95% CI: 0.49–2.05], 5 trials). The risk of bleeding was lower with aspirin than anticoagulants following hip fracture repair (RR: 0.32 [95% CI: 0.13–0.77], 2 trials), with a nonsignificant trend favoring aspirin after arthroplasty (RR: 0.63 [95% CI: 0.33–1.21], 5 trials). Rates of pulmonary embolism were too low to provide reliable estimates. CONCLUSION Compared with anticoagulation, aspirin may be associated with higher risk of DVT following hip fracture repair, although bleeding rates were substantially lower. Aspirin was similarly effective after lower extremity arthroplasty and may be associated with lower bleeding risk. Journal of Hospital Medicine 2014;9:579–585. © 2014 Society of Hospital Medicine

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“…Long-standing controversy exists surrounding the use of aspirin to prevent VTE [12]. Opponents of aspirin have maintained that it may not provide adequate reductions in life-threatening thromboembolic events, particularly within the low-flow, low-shear venous system where fibrin and red blood cell-rich clots predominate.…”

Section: The Role Of Aspirin In Vtementioning

confidence: 99%

“…This change was primarily driven by a shift towards basing recommendations on the use of prophylaxis to reduce ''patient-important'' symptomatic VTE events only, rather than also including asymptomatic events, as well as taking into consideration the hazard of symptomatic bleeding (i.e. net clinical benefit [12,26]). These significant changes in recommendations have come under considerable scrutiny [28].…”

Section: Differences Between Aaos and Accp Guidelines In The Orthopedmentioning

confidence: 99%

“…SCIP does not currently recognize aspirin as an appropriate sole prophylactic agent. However, aspirin can be used in a multimodal approach, along with mechanical devices, for patients who undergo elective THR/TKR or HFS and have contraindications to SCIP-recognized pharmacologic agents [12,29]. Beginning January 2014, the use of aspirin alone for THR/TKR and HFS will be endorsed by SCIP (http:// www.qualitynet.org/dcs/ContentServer?c=Page&pagename= QnetPublic%2FPage%2FQnetTier4&cid=1228773265583, accessed 30 Sep 2013).…”

Section: Differences Between Aaos and Accp Guidelines In The Orthopedmentioning

confidence: 99%

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Renaissance of Aspirin for the Primary and Secondary Prevention of Venous Thromboembolism

Burnett

Kelly

Horner

et al. 2013

Curr Emerg Hosp Med Rep

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Long-standing controversy has surrounded aspirin as an antithrombotic modality to prevent venous thromboembolism (VTE), particularly in the orthopedic surgery arena. New data are emerging on the use of aspirin for both primary VTE prevention and secondary prevention of recurrent VTE after an initial anticoagulation course. This review article will provide the history behind the controversy, information regarding recent or ongoing clinical trials of aspirin for primary VTE prevention in major orthopedic surgery, evidence for aspirin in secondary prevention of recurrent VTE, and suggestions for future research. Aspirin may be a reasonable option for VTE prevention in certain major orthopedic surgery patients. Additionally, investigation among non-orthopedic populations such as the acutely ill medical patient and the non-orthopedic surgery patient is encouraged to provide further safety and efficacy data.

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Aspirin for the Prophylaxis of Venous Thromboembolic Events in Orthopedic Surgery Patients: A Comparison of the AAOS and ACCP Guidelines with Review of the Evidence

Cited by 69 publications

References 42 publications

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: A systematic review and meta-analysis

Renaissance of Aspirin for the Primary and Secondary Prevention of Venous Thromboembolism

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