Direct Costs of Aspirin versus Warfarin for Venous Thromboembolism Prophylaxis after Total Knee or Hip Arthroplasty

Gutowski, Christina J.; Zmistowski, Benjamin; Lonner, Jess H.; Purtill, James J.; Parvızı, Javad

doi:10.1016/j.arth.2015.04.048

Cited by 40 publications

(23 citation statements)

References 13 publications

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“…A disadvantage of warfarin is international normalized ratio testing and dose adjustments, which aspirin does not require. Additional laboratory testing, lower complication rates [9,17], and shorter length of hospitalization [3] suggest that aspirin is more cost-effective than warfarin [92,93]. Nam et al [17] found that patients treated with aspirin after THA also had a higher patient satisfaction at 2 weeks and 4-6 weeks postop compared to patients treated with warfarin.…”

Section: Discussionmentioning

confidence: 99%

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

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Groff

Goswami

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

Azboy

Groff

Goswami

et al. 2020

The Journal of Arthroplasty

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“…Cost associated with TKA has been a subject of high interest in the orthopedic literature as demonstrated by many studies. [12][13][14][15][16][17][18][19] Factors such as length of stay, surgical implants, hospital volume, type of anesthesia, type of deep vein thrombosis prophylaxis, insurance carrier type, patient's age, smoking status, discharge disposition, postoperative infections and complications, and day of the week the surgery is performed on [12][13][14][15][16][17][18][19] have all been shown to influence TKA outcome and cost. In a prospective study, Wasielewski et al found that comorbidities were associated with a longer length of stay and higher hospital costs, as well as poorer patient-reported outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

et al. 2018

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Medical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294-26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

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“…Additional studies suggest that aspirin is a viable therapeutic option for VTE prophylaxis in patients stratified into groups with high risk of VTE events following total joint arthroplasty [28,34]. Also contributing to the appeal of aspirin as a first-line agent for chemical VTE prophylaxis is its low cost relative to alternative therapeutic options and its efficacy and safety profile when combined with other therapeutic agents such as intraoperative tranexamic acid [35,36]. It is appropriate to start aspirin post-operatively with the simultaneous resumption of pre-operative, chronic anticoagulation regimens with good efficacy given its mechanism of action outside of the traditional coagulation cascade.…”

Section: Emerging Trendsmentioning

confidence: 99%

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

et al. 2020

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Hip and knee arthroplasty patients are at high risk of perioperative venous thromboembolic events (VTE). VTE has been well studied in this population and it is recommended that total joint arthroplasty recipients receive chemoprophylactic anticoagulation due to risk factors inherent to the surgical intervention. There are few concise resources for the orthopedic surgeon that summarize data regarding post-operative anticoagulation in the context of currently available therapeutic options and perioperative standards of practice. The periodic reexamination of literature is essential as conclusions drawn from studies predating perioperative protocols that include early mobilization and sequential compression devices as standards of practice in total joint arthroplasty are no longer generalizable to modern-day practice. We reviewed a large number of recently published research studies related to post-operative anticoagulation in total joint arthroplasty populations that received a high Level of Evidence grade. Current literature supports the use of oral aspirin regimens in place of more aggressive anticoagulants, particularly among low risk patients. Oral aspirin regimens appear to have the additional benefit of lower rates of bleeding and wound complications. Less consensus exists among high risk patients and more potent anticoagulants may be indicated. However, available evidence does not demonstrate clear superiority among current options, all of which may place patients at a higher risk of bleeding and wound complications. In this situation, chemoprophylactic selection should reflect specific patient needs and characteristics.

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Direct Costs of Aspirin versus Warfarin for Venous Thromboembolism Prophylaxis after Total Knee or Hip Arthroplasty

Cited by 40 publications

References 13 publications

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

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