Fatal pulmonary embolism following elective total hip arthroplasty

Bayley, Edward; Brown, Sarah; Bhamber, Nivraj; Howard, Peter

doi:10.1302/0301-620x.98b5.34996

Cited by 30 publications

(32 citation statements)

References 35 publications

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“…The optimum duration for VTE prophylaxis remains controversial because the appropriate length of aspirin prophylaxis after TJA is not well studied. The studies included in this systematic review reported various durations of aspirin prophylaxis including 14 days [28,29,46,50], 21 days [52,58], 3 weeks [51], 1 month/4 weeks [11,34,35,37,40,44], 5 weeks [32], and 6 weeks [3,7,15,22,23,25,26,31,38,39,42,43,53,54]. We found no significant difference between incidence of PE or DVT and the different durations of aspirin treatment examined (<4 weeks, 4 weeks, and >4 weeks).…”

Section: Discussionmentioning

confidence: 81%

“…However, the appropriate dose of aspirin remains controversial. The studies included in this systematic review reported the various daily doses of aspirin of 75 mg/d [25,26], 81 mg/d [27], 100 mg/ d [28e30], 150 mg/d [31], 160 mg/d [11,32], 300 mg/d [33], 325 mg/ d [34e36], 650 mg/d [3,5e7,11,15,22e24,37e45], 1000 mg/d [46], 1200 mg/d [24,47e51], and 1300 mg/d [52e59]. Low-dose aspirin has been shown to be as effective as higher doses of aspirin in patients with acute coronary syndrome [64] and transient ischemic attack or minor stroke [65].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 81%

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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“…It has recently been shown that the incidence of mortality after arthroplasty is lower in patients using aspirin than in those using warfarin, 9 , 14 , 20 LMWH, ximelagatran, fondaparinux, or rivaroxaban. 14 , 138 Hunt et al 139 showed that mechanical and chemical thromboprophylaxis with heparin with or without aspirin were associated with a decreased 90-day mortality in 409 096 patients undergoing primary THA. They also reported 140 that the 45-day mortality with aspirin after TKA was slightly lower than the mortality with heparin, although this did not reach statistical significance.…”

Section: Does Aspirin Have Any Unintended Beneficial Effects?mentioning

confidence: 99%

“…The latter is not surprising as myocardial infarction and not PE is the main cause of mortality following arthroplasty. 141 PE is responsible for between 11.7% and 17.1% of 90-day mortality, 138 , 141 , 142 while a myocardial infarction is responsible for 25.9%. 141 The true cause of death in many patients who do not have an autopsy remains unknown.…”

Section: Does Aspirin Have Any Unintended Beneficial Effects?mentioning

confidence: 99%

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty

Azboy

Barrack

Thomas

et al. 2017

The Bone & Joint Journal

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The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences.Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a ‘milder’ agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents.The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use. There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE.Cite this article: Bone Joint J 2017;99-B:1420–30.

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“…Recent changes in the guidelines of both the AAOS and the ACCP converge in favor of aspirin use in the context of a multimodal approach in correctly selected patients. Bayley et al [33], in a prospective study involving 7983 THAs, suggest aspirin as an appropriate thromboprophylactic agent as part of a multimodal regimen, noting that pulmonary embolism is rare in this context and that potent anticoagulants have a higher rate of complications.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Stratified Approach for Prevention of Thromboembolism in Patients Undergoing Total Hip Arthroplasty

Loures¹,

Rocha²,

Loures³

et al. 2018

OJO

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Objective: To demonstrate the efficacy and safety of a multimodal stratified approach for prevention of thromboembolism in patients undergoing primary total hip arthroplasty. Method: A longitudinal retrospective clinical study of a cohort of 341 individuals undergoing total hip arthroplasty between March 2008 and July 2016. Of these, 242 patients met the criteria for inclusion in the study. Individuals with a history of deep vein thrombosis or pulmonary thromboembolism, thrombophilia, hypercoagulation conditions, and chronic users of anticoagulants before surgery received enoxaparin at a dose of 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed at a dose of 200 mg/day for 30 days. All patients had surgical risk assessed by the American Anesthesiology Association classified as I or II, and underwent regional anesthesia, effective hydration, the same protocol of early postoperative rehabilitation, and the use of compression stockings. Drug cost analysis was performed based on the Brasíndice. To date, there are no publications in PubMed and Scielo on this subject regarding the Brazilian population. Results: The need for blood transfusion in the enoxaparin group was higher and the overall complication and hemorrhagic rates were also significantly higher (p < 0.010) in this group. Aspirin prescription costs 39 times less than enoxaparin. Conclusion: In patients without predisposing factors to thromboembolism and undergoing primary total hip arthroplasty, the multimodal approach with acetylsalicylic acid seems to be effective, with low cost and a low rate of complications.

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Fatal pulmonary embolism following elective total hip arthroplasty

Abstract: This study proposes that aspirin may be an appropriate thromboprophylaxis agent when used as part of a multi-modal regimen, suggesting current guidelines should be reviewed. Cite this article: Bone Joint J 2016;98-B:585-8.

Cited by 30 publications

References 35 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

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty

Multimodal Stratified Approach for Prevention of Thromboembolism in Patients Undergoing Total Hip Arthroplasty

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