Aspirin response variability after major orthopedic surgery

Li, Chunjian; Hirsh, Jack; Sloane, Debi; Bai, Jianling; Paikin, Jeremy S.; Johnston, Marilyn; DeBeer, Justin; Eikelboom, John W.

doi:10.1016/j.thromres.2012.04.006

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…There is also the consideration of altered platelet function in surgical patients; decreased aspirin responsiveness has been observed in orthopedic surgery populations, but the clinical implications of this observation are yet to be elucidated. 38…”

Section: Bleeding Rates With Aspirinmentioning

confidence: 99%

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

Freshour

2013

Ann Pharmacother

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Recent changes to both the ACCP and AAOS guidelines are in agreement for those who choose to use aspirin for chemoprophylaxis of VTE. Current surgical care improvement project measures do not include aspirin as an appropriate sole option for the prevention of VTE, but in patients undergoing elective TKA or who have a contraindication to pharmacologic prophylaxis and undergo a THA or HFS, aspirin in conjunction with compression devices as part of a multimodal approach would meet these measures. Data do not support the hypothesis that aspirin is less likely to cause adverse bleeding events than more potent anticoagulants.

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Section: Bleeding Rates With Aspirinmentioning

confidence: 99%

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

Freshour

2013

Ann Pharmacother

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“…This effect has been observed in both cardiac and orthopaedic surgery and is theorized to be due to increased platelet consumption and production in the postoperative period. 4 Patients receive acetaminophen 1000 mg every 8 hours and celecoxib 200 mg every 12 hours, or meloxicam 15 mg once daily for patients allergic to sulfa, for multimodal pain management, unless they meet exclusion criteria to any of these agents. Patients are prescribed as needed opiates in doses for mild, moderate, or severe pain.…”

Section: Introductionmentioning

confidence: 99%

“…This effect has been observed in both cardiac and orthopaedic surgery and is theorized to be due to increased platelet consumption and production in the postoperative period. 4 …”

Section: Introductionmentioning

confidence: 99%

Interaction Between Low-Dose Aspirin and Nonsteroidal Anti-Inflammatory Drugs Can Compromise Aspirin’s Efficacy in Preventing Venous Thrombosis Following Total Joint Arthroplasty

Krauss

Cronin

Dengler

et al. 2020

Clin Appl Thromb Hemost

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Total joint arthroplasty is a rapid recovery procedure with patients optimized quickly in preparation for discharge. Two significant postoperative goals are effective pain management and prevention of postoperative venous thromboembolism (VTE). Low-risk patients receive aspirin 81 mg twice daily for VTE prophylaxis; this dosing regimen has been reduced over the past few years from 325 mg to 162 mg to 81 mg twice daily. Unless contraindications exist, all patients receive multimodal pain management that includes the use of celecoxib or meloxicam. Upon reduction of the aspirin dose to 81 mg twice daily, we rapidly identified 2 patients who developed a pulmonary embolus when celecoxib or meloxicam was administered concurrently with aspirin. The interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin varies among the different NSAIDs. It is also highly dependent on numerous factors, including time of administration, dose of aspirin, and both pharmacodynamics and dose of the NSAID. Real-world outcomes of concomitant administration of NSAIDs with low-dose aspirin led to increased incidence of VTE, possibly due to competitive inhibition of aspirin at platelet receptor sites. This interaction was mitigated by altering the administration times of both agents.

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“…The mechanism of postoperative aspirin resistance is still uncertain. Our previous study suggested that greater platelet turnover due to bone marrow hyperplasia caused by hemorrhage may account for impaired postoperative response to aspirin, either due to an increased number of circulating non-aspirinated platelets or an increased number of reticulated platelets that retain the ability to synthesize thromboxane through the COX-2 pathway[14]. From this point of view, higher or more frequent doses of aspirin during the postoperative period may enhance the efficacy of aspirin.…”

Section: Discussionmentioning

confidence: 99%

Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery

et al. 2014

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We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual antiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachidonic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs. 32.1%, 34.5% vs. 10.7%, respectively, both P < 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.

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Aspirin response variability after major orthopedic surgery

Cited by 10 publications

References 24 publications

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

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

Interaction Between Low-Dose Aspirin and Nonsteroidal Anti-Inflammatory Drugs Can Compromise Aspirin’s Efficacy in Preventing Venous Thrombosis Following Total Joint Arthroplasty

Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery

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