Aspirin Administered for Venous Thromboembolism Prophylaxis May Protect Against Stiffness Following Total Knee Arthroplasty

Published:January 09, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.008

      Abstract

      Background

      Aspirin has become the main agent for venous thromboembolism (VTE) prophylaxis following total knee arthroplasty (TKA). This study assesed whether aspirin is associated with less knee stiffness compared to warfarin and other chemoprophylaxis agents.

      Methods

      This was a retrospective review of all primary and revision TKA performed between January 2009 and October 2020 at a high volume institution. Demographics, comorbidity data and operative variables were extracted from medical records. VTE prophylaxis administered during this time period included aspirin, warfarin, and “others” (factor Xa, Unfractionated Heparin, low molecular weight heparin, fondaparinux, ADP receptor inhibitor and direct thrombin inhibitor). The primary outcome assessed was manipulation under anesthesia (MUA) performed within 6 months of index surgery. Secondary outcome included major bleeding events (MBE). Univariate followed by multivariate regression analysis were performed.

      Results

      A total of 15,903 cases were included in the study, of which 531 (3.3%) patients developed stiffness that required MUA. The rates of MUA were 2.7% (251/9223) for patients receiving aspirin, 4.2% (238/5709) for patients receiving warfarin and 4.3% (42/971) for all others (p’s<0.001). Multivariate regression analysis confirmed that aspirin is associated with lower rates of VTE compared to warfarin (adjusted odds ratio 1.423. 95% CI 1.158-1.747, p<0.001) and compared to other anticoagulation medications (adjusted odds ratio 1.742, 95% CI 1.122-2.704, p=0.013). MBE were also significantly lower in patients who received aspirin compared to the other 2 groups (p’s=0.001).

      Conclusion

      Aspirin prophylaxis is associated with lower rates of MUA following TKA compared to warfarin and other VTE chemoprophylactic agents when grouped together.

      Keywords

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