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Aspirin and arthroplasty

Sarav S Shah, Alexander M Satin, James R Mullen, Sara Merwin, Mark Goldin, Nicholas A Sgaglione
BACKGROUND: Prior to 2012, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) differed in their recommendations for postoperative pharmacologic venous thromboembolism prophylaxis (VTEP) after total joint arthroplasty. More specifically, aspirin (ASA) monotherapy was not endorsed by the ACCP as an acceptable prophylaxis. In 2012, the ACCP supported ASA monotherapy compared with no prophylaxis. Our aim was to investigate the impact of the convergence of ACCP and AAOS recommendations on surgeon prescribing patterns after knee arthroplasty (KA)...
October 20, 2016: Journal of Orthopaedic Surgery and Research
Rahel Meier, Regula Marthy, Christoph H Saely, Markus S Kuster, Karlmeinrad Giesinger, Hans Rickli
INTRODUCTION: Preoperative discontinuation of aspirin (acetylsalicylic acid) can reduce bleeding risk but may increase the risk of perioperative cardiovascular events. MATERIALS AND METHODS: We retrospectively assessed the impact of preoperative continuation versus discontinuation of aspirin compared with a control group in a cohort of 739 consecutive patients undergoing total hip (THA) (n = 396) or knee arthroplasty (TKA) (n = 343) at a tertiary hospital. Bleeding risk, local complications, orthopaedic outcome, and cardiac and cerebral complications were assessed...
September 9, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Kara N Radzak, Jennifer J Wages, Kimberly E Hall, Cass K Nakasone
BACKGROUND: Controversy continues regarding the use of powerful anticoagulants for venous thromboembolism prophylaxis in patients undergoing total knee arthroplasty (TKA). To comply with institution-mandated guidelines and pressure from hospitalist intent on complying with conventionally recommended anticoagulation guidelines, we singularly changed our chemoprophylaxis practice from using aspirin to Lovenox and noted that transfusion rates increased substantially. METHODS: A retrospective case review was performed to evaluate transfusion requirement differences in primary TKA patients receiving Lovenox (unilateral TKA: n = 135, bilateral TKA: n = 44) or aspirin (unilateral TKA: n = 153, bilateral TKA: n = 45) for venous thromboembolism prophylaxis...
November 2016: Journal of Arthroplasty
Melissa A Herschman, Frank S Rigelsky, Sandra S Axtell
PURPOSE: A pilot study was conducted to determine whether rivaroxaban (Xarelto, Janssen Pharmaceuticals) resulted in a lower 30-day all-cause readmission rate compared with enoxaparin (Lovenox, Sanofi-Aventis) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a community hospital. METHODS: The study was a single-center, retrospective, chart-review investigation involving patients who underwent THA or TKA between May 2013 and May 2014. The study's primary endpoint was the 30-day all-cause readmission rate...
June 2016: P & T: a Peer-reviewed Journal for Formulary Management
Vincent V G An, Kevin Phan, Yadin D Levy, Warwick J M Bruce
BACKGROUND: Venous thromboembolism (VTE) comprises pulmonary embolism and deep vein thrombosis and is a complication of particular concern in lower limb arthroplasty. In recent years, aspirin has emerged as a potential alternative thromboprophylactic agent, particularly after its acceptance as a recommended agent by the American College of Chest Physicians. Aspirin is favorable due to its relative cost-effectiveness and convenience compared to novel oral anticoagulants and warfarin. However, its efficacy since its inclusion in the American College of Chest Physicians guidelines remains unclear...
April 13, 2016: Journal of Arthroplasty
E Bayley, S Brown, N S Bhamber, P W Howard
AIMS: The place of thromboprophylaxis in arthroplasty surgery remains controversial, with a challenging requirement to balance prevention of potentially fatal venous thrombo-embolism with minimising wound-related complications leading to deep infection. We compared the incidence of fatal pulmonary embolism in patients undergoing elective primary total hip arthroplasty (THA) between those receiving aspirin, warfarin and low molecular weight heparin (LMWH) for the chemical component of a multi-modal thromboprophylaxis regime...
May 2016: Bone & Joint Journal
Gregory K Deirmengian, Snir Heller, Eric B Smith, Mitchell Maltenfort, Antonia F Chen, Javad Parvizi
BACKGROUND: The optimal prophylaxis for prevention of venous thromboembolic events (VTEs) after revision total joint arthroplasty (TJA) remains unknown. The objective of this study was to evaluate whether aspirin, known to be effective for prevention of VTEs after primary arthroplasty, is also effective after revision TJA. METHODS: We studied 2997 consecutive patients who underwent revision TJA between 2005 and 2013 and were treated with intermittent pneumatic compression devices and either aspirin (534 patients) or warfarin (2463 patients) for VTE prophylaxis...
October 2016: Journal of Arthroplasty
Ronald C Huang, Javad Parvizi, William J Hozack, Antonia F Chen, Matthew S Austin
BACKGROUND: There is continued controversy regarding the optimal venous thromboembolism (VTE) prophylaxis, particularly for total joint arthroplasty (TJA) patients at higher risk. The purpose of this study was to compare the efficacy of aspirin (ASA) to warfarin in patients with higher risk of VTE. METHODS: This retrospective study examined 30,270 patients who received ASA or warfarin for VTE prophylaxis after TJA. Using a previously developed risk stratification model, patients were classified into low or high VTE risk categories...
September 2016: Journal of Arthroplasty
Khalid Odeh, James Doran, Stephen Yu, Nicholas Bolz, Joseph Bosco, Richard Iorio
BACKGROUND: Venous thromboembolism (VTE) is a major concern after total joint arthroplasty (TJA). We evaluated a risk-stratified prophylaxis protocol for patients undergoing TJA. METHODS: A total of 2611 TJA patients were retrospectively studied. Patients treated with an aggressive VTE chemoprophylaxis protocol were compared with patients treated with a risk-stratified protocol utilizing aspirin and sequential pneumatic compression devices (SPCDs) for standard-risk patients and targeted anticoagulation for high-risk patients...
September 2016: Journal of Arthroplasty
Juan C Suarez, Colin A McNamara, Leticia C Barksdale, Cecilia Calvo, Caleb R Szubski, Preetesh D Patel
BACKGROUND: Many studies have challenged routine drain placement in patients undergoing total hip arthroplasty. Some studies suggest increased transfusion rate with the use of closed suction drains. The use of tranexamic acid to control surgical bleeding and aspirin for venous thromboembolism prophylaxis has gained popularity. No study has evaluated the use of drains in patients undergoing direct anterior total hip arthroplasty under these conditions. METHODS: We performed a prospective, randomized study in patients undergoing direct anterior total hip arthroplasty to evaluate whether closed suction drain placement provides any clinical benefit...
September 2016: Journal of Arthroplasty
Snir Heller, Eric Secrist, Alisina Shahi, Antonia F Chen, Javad Parvizi
BACKGROUND: Venous thromboembolism (VTE) is not uncommon after total joint arthroplasty (TJA). Various prophylactic agents have been used to minimize this complication after TJA. Numerous studies have demonstrated that acetylsalicylic acid (ASA) has equivalent efficacy to other agents in preventing VTE after TJA. However, some have expressed theoretical concern that ASA may not be an adequate VTE prophylaxis in TJA patients receiving tranexamic acid (TA), which is an antifibrinolytic agent...
July 2016: Journal of Arthroplasty
Nicolas K Khattar, Phillip V Parry, Nitin Agarwal, Hope K George, Eric S Kretz, Timothy M Larkin, Gary S Gruen, Adnan A Abla
Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis...
March 2016: Orthopedics
L Ogonda, J Hill, E Doran, J Dennison, M Stevenson, D Beverland
AIMS: The aim of this study was to present data on 11 459 patients who underwent total hip (THA), total knee (TKA) or unicompartmental knee arthroplasty (UKA) between November 2002 and April 2014 with aspirin as the primary agent for pharmacological thromboprophylaxis. PATIENTS AND METHODS: We analysed the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) then compared the 90-day all-cause mortality with the corresponding data in the National Joint Registry for England and Wales (NJR)...
March 2016: Bone & Joint Journal
Nafisseh S Warner, Christopher M Duncan, Sandra L Kopp
Retroperitoneal hematoma is a rare complication of psoas catheter placement, typically occurring several days after placement and in the setting of anticoagulation. We present the case of a patient with a history of myeloproliferative thrombocytosis receiving aspirin therapy who underwent total hip arthroplasty with preoperative psoas catheter placement complicated by immediate development of a large retroperitoneal hematoma. It is likely that the combination of aspirin therapy and thrombocytosis paradoxically placed the patient at increased risk for hemorrhagic complications...
January 15, 2016: A & A Case Reports
Denis Nam, Ryan M Nunley, Staci R Johnson, James A Keeney, John C Clohisy, Robert L Barrack
BACKGROUND: This study's purpose was to present our institution's experience with the use of a risk stratification protocol for venous thromboembolism (VTE) prophylaxis in joint arthroplasty in which "routine" risk patients receive a mobile compression device in conjunction with aspirin and "high"-risk patients receive warfarin for thromboprophylaxis. METHODS: This was a prospective study of patients undergoing primary or revision knee or hip arthroplasty. Exclusion criteria were patients with a current deep vein thrombosis, history of pulmonary embolism, chronic warfarin therapy, planned multiple surgeries, and prolonged postoperative immobilization...
June 2016: Journal of Arthroplasty
Andrew J Bryan, Thomas L Sanders, Robert T Trousdale, Rafael J Sierra
Bernese (Ganz) periacetabular osteotomy is associated with significant blood loss and the need for perioperative transfusion. Tranexamic acid decreases blood loss and minimizes transfusion rates in total joint arthroplasty. However, no reports have described its use in patients undergoing Bernese periacetabular osteotomy. This study reports the use of intravenous tranexamic acid in these patients. The study included 137 patients (150 hips) who underwent isolated periacetabular osteotomy at a single institution between 2003 and 2014...
January 2016: Orthopedics
Young Gon Na, Rui Fang, Yeon Ho Kim, Kwan Jae Cho, Tae Kyun Kim
We sought to document the clinical performance of the 1st American Academy of Orthopaedic Surgeons (AAOS) guideline on the prevention of symptomatic pulmonary embolism (PE) after total knee arthroplasty (TKA) in Korean patients, in terms of the proportions of the each risk-stratified group, efficacy and safety. Consecutive 328 patients underwent TKA were preoperatively assessed for the risks of PE and bleeding and categorized into 4 groups: 1) standard risk, 2) high risk for PE, 3) high risk for bleeding, and 4) high risks both for PE and bleeding...
December 2015: Journal of Korean Medical Science
Deborah Wittig-Wells, Melinda Higgins, Erica Davis, Ifeya Johnson, Latalya Louis, Olga Mason, Jacqueline Samms-McPherson, Sandra Sims, Ani Jacob
BACKGROUND: Patient education for the use and administration of aspirin (ASA) as an anticoagulant may be deficient. PURPOSE: To pilot a knowledge assessment tool regarding the use of aspirin (ASA) as an anticoagulant and to evaluate the impact of a focused approach for discharge teaching. DESIGN: One-group pretest-posttest pilot study. SAMPLE: Convenience sample of patients hospitalized for total knee and total hip arthroplasty...
July 2015: Orthopaedic Nursing
Ronald Huang, Patrick S Buckley, Benjamin Scott, Javad Parvizi, James J Purtill
The efficacy and safety of aspirin (ASA) for prevention of venous thromboembolism (VTE) following total joint arthroplasty (TJA) have been demonstrated. Our hypothesis was that postoperative ASA compared to warfarin lowers the incidence of periprosthetic joint infection (PJI). Between January 2006 and December 2012, 1456 patients received ASA and 1700 patients received warfarin following primary TJA as standard VTE prophylaxis. Logistic regression was utilized to identify independent risk factors of PJI. Incidence of PJI was significantly lower at 0...
September 2015: Journal of Arthroplasty
Denis Nam, Ryan M Nunley, Staci R Johnson, James A Keeney, John C Clohisy, Robert L Barrack
This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0...
December 2015: Journal of Arthroplasty
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