Venous thromboprophylaxis after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors?

Apr 17, 2019Hip international : the journal of clinical and experimental research on hip pathology and therapy

Preventing blood clots after hip replacement: aspirin, warfarin, enoxaparin, or factor Xa blockers?

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Abstract

Aspirin use increased by 33% among patients undergoing total hip arthroplasty from 2007 to 2016.

Factor Xa inhibitors and aspirin were associated with the lowest incidence of deep venous thrombosis (DVT) at 1.7% each by 90 days.
Warfarin and enoxaparin had higher DVT rates at 3.7% and 2.6%, respectively, at 90 days.
Aspirin and factor Xa inhibitors also had the lowest blood transfusion rates at 12%, compared to 15% for warfarin and 17% for enoxaparin.
No significant differences were found in the incidence of bleeding-related complications or symptomatic pulmonary embolism (PE) among the agents.

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INTRODUCTION: Debate over the ideal agent for venous thromboembolism (VTE) prophylaxis after total hip arthroplasty (THA) has led to changes in prescribing trends of commonly used agents. We investigate variation in utilisation and the differences in VTE incidence and bleeding risk in primary THA after administration of aspirin, warfarin, enoxaparin, or factor Xa inhibitors.

METHODS: 8829 patients were age/sex matched from a large database of primary THAs performed between 2007 and 2016. Utilisation was calculated using compound annual growth rate. Incidence of postoperative deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding-related complications, postoperative anaemia, and transfusion were identified at 2 weeks, 30 days, 6 weeks, and 90 days.

RESULTS: Aspirin use increased by 33%, enoxaparin by 7%, and factor Xa inhibitors by 31%. Warfarin use decreased by 1%. Factor Xa inhibitors (1.7%) and aspirin (1.7%) had the lowest incidence of DVT followed by enoxaparin (2.6%), and warfarin (3.7%) at 90 days. Factor Xa inhibitors (12%) and aspirin (12%) had the lowest incidence of blood transfusion followed by warfarin (15%) and enoxaparin (17%) at 90 days. There was no difference in incidence of blood transfusion or bleeding-related complications nor any detectable difference in symptomatic PE incidence.

CONCLUSIONS: The utilisation of aspirin and factor Xa inhibitors increased over time. Aspirin and factor Xa inhibitors provided improved DVT prophylaxis with lower rates of postoperative anaemia compared to enoxaparin and warfarin.

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Venous thromboprophylaxis after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors?

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