Safety and Efficacy of Aspirin Compared to Enoxaparin Following Total Hip and Total Knee Arthroplasty Among Patients Who Have a History of Venous Thromboembolic Disease

Nov 19, 2024The Journal of arthroplasty

Safety and effectiveness of aspirin versus enoxaparin after hip or knee replacement in patients with past blood clots

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Abstract

1,429 total hip arthroplasty (THA) and 2,864 total knee arthroplasty (TKA) patients were evaluated for venous thromboembolism (VTE) prophylaxis using aspirin or enoxaparin.

Aspirin (ASA) and enoxaparin showed similar risks of pulmonary embolism in both THA and TKA patients.
In TKA patients, ASA was associated with a lower risk of deep vein thrombosis (DVT) compared to enoxaparin.
THA patients receiving ASA demonstrated a significantly reduced risk of stroke.
ASA was linked to a lower risk of acute blood loss anemia in TKA patients.
Overall, ASA did not increase the risk of adverse outcomes in high-risk patients compared to enoxaparin.

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BACKGROUND: Despite the broad utilization of aspirin (ASA) as a venous thromboembolism (VTE) chemoprophylactic agent following total knee arthroplasty (TKA) and total hip arthroplasty (THA), few studies have evaluated its safety and efficacy in patients who had a history of VTE. This study sought to evaluate the safety and efficacy of ASA relative to enoxaparin in high-risk total joint arthroplasty patients.

METHODS: An all-payer claims database was queried for primary, elective THA, and TKA patients from January 2015 to December 2021. Patients who had a history of VTE were divided based on receipt of either ASA or enoxaparin as VTE prophylaxis. In a 1:1 ratio, 1,429 THA and 2,864 TKA high-risk ASA patients were matched to high-risk enoxaparin patients on age, sex, race, and presence of pertinent comorbidities. Multivariable regression analyses accounted for potential confounders.

RESULTS: After multivariable analyses, similar risk of pulmonary embolism (THA: adjusted odds ratio [aOR]: 0.85, 95% confidence interval [CI]: 0.26 to 2.76; TKA: aOR: 0.71, 95% CI: 0.38 to 1.32) and deep vein thrombosis (DVT) (THA: aOR: 1.12, 95% CI: 0.53 to 2.36) was observed in the ASA cohorts relative to the enoxaparin cohorts. TKA patients in the ASA cohort had a lower risk of DVT than those in the enoxaparin cohort (aOR: 0.57, 95% CI: 0.33 to 0.96). THA ASA patients demonstrated a reduced risk of stroke (aOR: 0.03, 95% CI: 0.00 to 0.73), while TKA ASA patients had a lower risk of acute blood loss anemia (aOR: 0.77, 95% CI: 0.66 to 0.88).

CONCLUSIONS: High-risk patients who received ASA demonstrated similar risk of pulmonary embolism and DVT, but decreased risk of bleeding-related and medical complications compared to patients who received enoxaparin. The utilization of ASA in high-risk patients was not associated with an increased risk of adverse outcomes.

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Safety and Efficacy of Aspirin Compared to Enoxaparin Following Total Hip and Total Knee Arthroplasty Among Patients Who Have a History of Venous Thromboembolic Disease

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