Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty

Parvızı, Javad; Huang, Ronald; Rezapoor, Maryam; Bagheri, Babak; Maltenfort, Mitchell

doi:10.1016/j.arth.2016.02.077

Cited by 85 publications

(112 citation statements)

References 16 publications

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“…At present, there is not yet a widely adopted risk stratification system that has been shown to effectively guide thromboprophylaxis strategies after arthroplasty. However, efforts to develop and test such risk stratification tools are underway[27]. …”

Section: Discussionmentioning

confidence: 99%

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

Chu

Maselli

Auerbach

et al. 2017

Thrombosis Research

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Background Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. We compared rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip or knee arthroplasty, using data from a large US-based administrative database. Materials and Methods We conducted a retrospective cohort study of 231,780 adults who underwent total knee arthroplasty and 110,621 who underwent total hip arthroplasty in 2009–2012 and who received pharmacologic VTE prophylaxis (aspirin or anticoagulant) within the first 7 days after surgery. We compared the risk of post-operative VTE between patients receiving aspirin-only vs. anticoagulants, controlling for clinical and hospital characteristics using multivariable logistic regression with propensity score adjustment. Results Aspirin-only prophylaxis was administered to 7.5% of patients after knee arthroplasty and 8.0% after hip arthroplasty. Post-operative VTE was diagnosed in 2,217 (0.96%) patients after knee arthroplasty and 454 (0.41%) after hip arthroplasty. Compared to anticoagulants, aspirin was not associated with a higher risk for post-operative VTE either after knee arthroplasty (adjusted odds ratio and 95% confidence interval [OR] 0.34 [0.24–0.48]) or hip arthroplasty (OR 0.82 [0.45–1.51]). Conclusions Aspirin was uncommonly administered as the sole prophylactic agent after hip or knee arthroplasty in this study. However, patients who received aspirin-only had similar rates of post-operative VTE compared to patients who received anticoagulants. Further research should focus on distinguishing which patients benefit more from anticoagulants versus aspirin after arthroplasty.

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Section: Discussionmentioning

confidence: 99%

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

Chu

Maselli

Auerbach

et al. 2017

Thrombosis Research

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show abstract

“…The remaining five articles met the inclusion criteria and were included in the review. [20][21][22][23][24] Table 1 summarizes characteristics of studies included in the review. Identified studies were published between 2012 and 2017.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

“…[20,22] Three studies reported use of post-operative pharmacological VTE thromboprophylaxis in patients which comprised a variety of agents including low-molecular-weight heparin (LMWH), warfarin, aspirin, and direct thrombin or factor Xa inhibitors (e.g., dabigatran, rivaroxaban, apixaban, etc). [20,23,24] Two studies reported having no records of the type of VTE prophylaxis received; [21,22] however, one of these studies validated the risk score externally in a different population of patients who received warfarin [22] ( Table 2). Quality assessment using the PROBAST tool showed evidence of high overall risk of bias throughout the included studies.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…A total of five risk scores were described in the five eligible studies. Three risk scores were derivations of risk models on a base population [20][21][22] and two studies attempted to validate existing risk scores that had been developed in different populations or used different outcomes. [23,24] None of the risk models was developed in a cohort designed for this sole purpose; they all retrospectively used data that had been prospectively collected for different purposes.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…[23,24] None of the risk models was developed in a cohort designed for this sole purpose; they all retrospectively used data that had been prospectively collected for different purposes. Two studies employed logistic regression techniques in their model development [20,21] and one employed Cox regression. [22] The component risk factors varied from score to score and ranged in number from 5 to 26.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of risk prediction scores for venous thromboembolism following joint replacement

Kunutsor

Beswick

Whitehouse

et al. 2018

Thrombosis Research

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Should Aspirin Be Routinely Used for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty?

Sterling

Haut

2019

JAMA Surg

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Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty

Cited by 85 publications

References 16 publications

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

Systematic review of risk prediction scores for venous thromboembolism following joint replacement

Should Aspirin Be Routinely Used for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty?

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