Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty

Jan 3, 2018The bone & joint journal

Preventing blood clots after both knees are replaced at the same time: aspirin versus warfarin

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Abstract

The adjusted incidence of pulmonary embolism following simultaneous bilateral total knee arthroplasty was 1.0% with aspirin compared to 2.2% with warfarin.

Aspirin reduced the risk of pulmonary embolism by 66% and venous thromboembolism by 38% compared to warfarin.
The incidence of venous thromboembolism following simultaneous bilateral total knee arthroplasty was 1.6% with aspirin and 2.5% with warfarin.
Patients undergoing simultaneous bilateral total knee arthroplasty had a 204% higher risk of pulmonary embolism compared to those undergoing unilateral knee arthroplasty.
For every ten-point increase in baseline venous thromboembolism risk, the risk of pulmonary embolism increased by 25.5% for simultaneous bilateral total knee arthroplasty patients.
Patients with a history of myocardial infarction or peripheral vascular disease experienced the greatest increase in risk associated with simultaneous bilateral total knee arthroplasty.

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AIMS: The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA).

PATIENTS AND METHODS: A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk.

RESULTS: The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA.

CONCLUSION: Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for those with significant underlying risk factors. Patients should be informed about the risks associated with undergoing SBTKA. Cite this article:2018;100-B(1 Supple A):68-75. Bone Joint J

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Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty

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