SLR - November 2023 - Clellen
Title: Efficacy of Low-Dose vs. High-Dose Aspirin for Venous Thromboembolism Prophylaxis in Total Hip and Knee Arthroplasty: A Retrospective Cohort StudyReferences: Duke A, Bowen S, Baig S, Cohen D, Komatsu D, Nicholson J. Thirty day low-dose versus regular-dose aspirin for venous thromboembolism prophylaxis in primary total joint arthroplasty. Journal of Orthopaedic Surgery. 2023 May 3;31(2).
Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Samuel Clellen DPM, MBA, PGY3
Residency Program: HCA Florida Northwest Hospital, Margate, FL.
Podiatric Relevance: This article is relevant to podiatric surgeons as it addresses VTE prophylaxis in lower extremity joint arthroplasty. Although these specific procedures are not performed by podiatric surgeons, the data presented can be extrapolated and provide us with recommended aspirin dosing, which our patients often take during the non-weightbearing, postoperative period. Understanding the optimal aspirin dosage for VTE prophylaxis in these patients can help guide clinical decisions and potentially reduce the risk of postoperative complications. The primary clinical question addressed in this study is whether low-dose ASA (81 mg BID) is as effective as high-dose ASA (325 mg QD) in preventing symptomatic VTE after primary THA and TKA. Additionally, the study explores the safety of both ASA dosing regimens, particularly with regard to bleeding, wound complications, and deep infection. The study's findings may be valuable in improving patient outcomes and safety in podiatric surgery.
Methods: The study is a retrospective cohort study conducted at a tertiary, suburban, academic institution over a two-year period. It includes 625 primary surgeries (323 THA and 302 TKA) among 483 consecutive patients. Patients were categorized into two groups based on the aspirin dosage used for postoperative VTE prophylaxis. The study assessed patient demographics, VTE incidence, major bleeding events, surgical site complications/infections, and other relevant variables.
Results: The study found that the incidence of symptomatic VTE was not significantly different between the low-dose (1.5%) and high-dose (2.7%) aspirin groups. However, the high-dose group had a significantly higher rate of major bleeding events (7.6%) compared to the low-dose group (2.5%). There were no significant differences in deep infection rates between the two groups. Suture reactions were more common in the high-dose group. General anesthesia was more frequently used in the low-dose aspirin group during the study period, possibly due to the timing of the COVID-19 pandemic.
Conclusions: The study concludes that low-dose aspirin is effective for VTE prophylaxis in patients undergoing primary THA and TKA, with similar VTE rates but a lower risk of major bleeding events compared to high-dose aspirin. The findings suggest that low-dose aspirin may be a safer alternative for VTE prophylaxis in this patient population without compromising efficacy. Further research is needed to explore other low-dose aspirin regimens and their impact on bleeding and wound complications while effectively preventing VTE events.