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Farey JE, Hooper T, Alland T, Naylor JM, Kelly TL, Lorimer M, Lewin AM, Rogers M, Law CK, Close J, Graves SE, de Steiger RS, Lewis PL, Adie S, Harris IA. Dual mobility versus conventional total hip arthroplasty in femoral neck fractures (DISTINCT): protocol for a registry-nested, open-label, cluster-randomised crossover trial. BMJ Open 2022; 12:e064478. [PMID: 36130765 PMCID: PMC9494585 DOI: 10.1136/bmjopen-2022-064478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hip fractures treated with total hip arthroplasty (THA) are at high risk of prosthesis instability, and dislocation is the most common indication for revision surgery. This study aims to determine whether dual mobility THA implants reduce the risk of dislocation compared with conventional THA in patients with hip fracture suitable to be treated with THA. METHODS AND ANALYSIS This is a cluster-randomised, crossover, open-label trial nested within the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The clusters will comprise hospitals that perform at least 12 THAs for hip fracture per annum. All adults age ≥50 years who meet the Australian and New Zealand Hip Fracture Registry guidelines for THA will be included. The intervention will be dual mobility THA and the comparator will be conventional THA. Each hospital will be allocated to two consecutive periods, one of dual mobility THA and the other of conventional THA in random order, aiming for an average of 16 patients eligible for the primary analysis per group (32 total per site), allowing different recruitment totals between sites. Data will be collected through the AOANJRR and linked with patient-level discharge data acquired through government agencies. The primary outcome is dislocation within 1 year. Secondary outcomes include revision surgery for dislocation and all-cause, complications and mortality at 1, 2 and 5 years. If dual mobility THA is found to be superior, a cost-effectiveness analysis will be conducted. The study will aim to recruit 1536 patients from at least 48 hospitals over 3 years. ETHICS AND DISSEMINATION Ethics approval has been granted (Sydney Local Health District - Royal Prince Alfred Hospital Zone (approval X20-0162 and 2020/ETH00680) and site-specific approvals). Participant recruitment is via an opt-out consent process as both treatments are considered accepted, standard practice. The trial is endorsed by the Australia and New Zealand Musculoskeletal Clinical Trials Network. TRIAL REGISTRATION NUMBER ACTRN12621000069853.
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Affiliation(s)
- John E Farey
- Institute for Musculoskeletal Health, King George V Building, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Tamara Hooper
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Tania Alland
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Justine M Naylor
- DISTINCT Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Adriane M Lewin
- DISTINCT Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- South West Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Margaret Rogers
- University of New South Wales - St George Campus, Sydney, New South Wales, Australia
| | - Chi Kin Law
- Clinical Trials Centre, National Health and Medical Research Council, University of Sydney, Camperdown, New South Wales, Australia
| | - Jacqueline Close
- Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Steven E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard S de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
- Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia
| | - Peter L Lewis
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Sam Adie
- DISTINCT Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- University of New South Wales - St George Campus, Sydney, New South Wales, Australia
| | - Ian A Harris
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
- DISTINCT Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
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Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, Cashman K, Ackerman I, Bastiras D, Brighton R, Burns AWR, Chong BH, Clavisi O, Cripps M, Dekkers M, de Steiger R, Dixon M, Ellis A, Griffith EC, Hale D, Hansen A, Harris A, Hau R, Horsley M, James D, Khorshid O, Kuo L, Lewis P, Lieu D, Lorimer M, MacDessi S, McCombe P, McDougall C, Mulford J, Naylor JM, Page RS, Radovanovic J, Solomon M, Sorial R, Summersell P, Tran P, Walter WL, Webb S, Wilson C, Wysocki D, Harris IA. Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial. JAMA 2022; 328:719-727. [PMID: 35997730 PMCID: PMC9399863 DOI: 10.1001/jama.2022.13416] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE There remains a lack of randomized trials investigating aspirin monotherapy for symptomatic venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) or total knee arthroplasty (TKA). OBJECTIVE To determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE after THA or TKA. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized, crossover, registry-nested trial across 31 hospitals in Australia. Clusters were hospitals performing greater than 250 THA or TKA procedures annually. Patients (aged ≥18 years) undergoing hip or knee arthroplasty procedures were enrolled at each hospital. Patients receiving preoperative anticoagulation or who had a medical contraindication to either study drug were excluded. A total of 9711 eligible patients were enrolled (5675 in the aspirin group and 4036 in the enoxaparin group) between April 20, 2019, and December 18, 2020. Final follow-up occurred on August 14, 2021. INTERVENTIONS Hospitals were randomized to administer aspirin (100 mg/d) or enoxaparin (40 mg/d) for 35 days after THA and for 14 days after TKA. Crossover occurred after the patient enrollment target had been met for the first group. All 31 hospitals were initially randomized and 16 crossed over prior to trial cessation. MAIN OUTCOMES AND MEASURES The primary outcome was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis (DVT) (above or below the knee). The noninferiority margin was 1%. Six secondary outcomes are reported, including death and major bleeding within 90 days. Analyses were performed by randomization group. RESULTS Enrollment was stopped after an interim analysis determined the stopping rule was met, with 9711 patients (median age, 68 years; 56.8% female) of the prespecified 15 562 enrolled (62%). Of these, 9203 (95%) completed the trial. Within 90 days of surgery, symptomatic VTE occurred in 256 patients, including pulmonary embolism (79 cases), above-knee DVT (18 cases), and below-knee DVT (174 cases). The symptomatic VTE rate in the aspirin group was 3.45% and in the enoxaparin group was 1.82% (estimated difference, 1.97%; 95% CI, 0.54%-3.41%). This failed to meet the criterion for noninferiority for aspirin and was significantly superior for enoxaparin (P = .007). Of 6 secondary outcomes, none were significantly better in the enoxaparin group compared with the aspirin group. CONCLUSIONS AND RELEVANCE Among patients undergoing hip or knee arthroplasty for osteoarthritis, aspirin compared with enoxaparin resulted in a significantly higher rate of symptomatic VTE within 90 days, defined as below- or above-knee DVT or pulmonary embolism. These findings may be informed by a cost-effectiveness analysis. TRIAL REGISTRATION ANZCTR Identifier: ACTRN12618001879257.
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Affiliation(s)
| | - Verinder S Sidhu
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole Pratt
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia
| | - Sam Adie
- School of Clinical Medicine, UNSW Medicine and Health, St George and Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ilana Ackerman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia
| | - Durga Bastiras
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Roger Brighton
- Orthopaedic Department, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
- Orthopaedic Department, Lakeview Private Hospital, Baulkham Hills, Sydney, New South Wales, Australia
| | - Alexander W R Burns
- Orthopaedic Department, Calvary John James Hospital, Deakin, Canberra, Australian Capital Territory, Australia
| | - Beng Hock Chong
- Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Hematology, New South Wales Pathology, Kogarah Campus, Sydney, New South Wales, Australia
| | | | - Maggie Cripps
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Mark Dekkers
- Orthopaedic Department, Greenslopes Private Hospital, Greenslopes, Brisbane, Queensland, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dixon
- Orthopaedic Department, Kareena Private Hospital, Sutherland, Sydney, New South Wales, Australia
| | - Andrew Ellis
- Orthopaedic Department, Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health Flagship Centre of the University of Sydney and Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
| | - Elizabeth C Griffith
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Hale
- Orthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, Sydney, New South Wales, Australia
| | - Amber Hansen
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mark Horsley
- Orthopaedic Department, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Dugal James
- Bendigo Healthcare Group, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Omar Khorshid
- Orthopaedic Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Leonard Kuo
- Orthopaedic Department, Canterbury Hospital, Canterbury, Sydney, New South Wales, Australia
| | - Peter Lewis
- Orthopaedic Department, Calvary Hospital, Adelaide, South Australia, Australia
| | - David Lieu
- Orthopaedic Department, Fairfield Hospital, Fairfield, Sydney, New South Wales, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Samuel MacDessi
- School of Clinical Medicine, UNSW Medicine and Health, St George and Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
- Orthopaedic Department, St George Private Hospital, Kogarah, Sydney, New South Wales, Australia
| | - Peter McCombe
- Orthopaedic Department, Frankston Hospital, Frankston, Melbourne, Victoria, Australia
| | - Catherine McDougall
- Orthopaedic Department, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia
| | - Jonathan Mulford
- Orthopaedic Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Justine Maree Naylor
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Richard S Page
- School of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - John Radovanovic
- Orthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, Queensland, Australia
| | - Michael Solomon
- Orthopaedic Department, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
| | - Rami Sorial
- Orthopaedic Department, Nepean Hospital, Nepean, Sydney, New South Wales, Australia
| | - Peter Summersell
- Orthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia
| | - Phong Tran
- Orthopaedic Department, Western Health, Melbourne, Victoria, Australia
| | - William L Walter
- Orthopaedic Department, Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health Flagship Centre of the University of Sydney and Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Steve Webb
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Wilson
- Orthopaedic Department, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
- Department of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Wysocki
- Orthopaedic Department, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sidhu VS, Kelly TL, Pratt N, Graves S, Buchbinder R, Naylor J, de Steiger R, Ackerman I, Adie S, Lorimer M, Bastiras D, Cashman K, Harris I. CRISTAL (a cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study): statistical analysis plan. Trials 2021; 22:564. [PMID: 34429127 PMCID: PMC8383378 DOI: 10.1186/s13063-021-05486-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This a priori statistical analysis plan describes the analysis for CRISTAL. METHODS CRISTAL (cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study) aims to determine whether aspirin is non-inferior to low molecular weight heparin (LMWH) in preventing symptomatic venous thromboembolism (VTE) following hip arthroplasty (HA) or knee arthroplasty (KA). The study is nested within the Australian Orthopaedic Association National Joint Replacement Registry. The trial was commenced in April 2019 and after an unplanned interim analysis, recruitment was stopped (December 2020), as the stopping rule was met for the primary outcome. The clusters comprised hospitals performing > 250 HA and/or KA procedures per annum, whereby all adults (> 18 years) undergoing HA or KA were recruited. Each hospital was randomised to commence with aspirin, orally, 85-150 mg daily or LMWH (enoxaparin), 40 mg, subcutaneously, daily within 24 h postoperatively, for 35 days after HA and 14 days after KA. Crossover was planned once the registration target was met for the first arm. The primary end point is symptomatic VTE within 90 days. Secondary outcomes include readmission, reoperation, major bleeding and death within 90 days, and reoperation and patient-reported pain, function and health status at 6 months. The main analyses will focus on the primary and secondary outcomes for patients undergoing elective primary total HA and KA for osteoarthritis. The analysis will use an intention-to-treat approach with cluster summary methods to compare treatment arms. As the trial stopped early, analyses will account for incomplete cluster crossover and unequal cluster sizes. CONCLUSIONS This paper provides a detailed statistical analysis plan for CRISTAL. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12618001879257 . Registered on 19/11/2018.
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Affiliation(s)
- Verinder Singh Sidhu
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South West Sydney Clinical School, The University of New South Wales Sydney, Sydney, NSW, Australia.
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Nicole Pratt
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Steven Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South West Sydney Clinical School, The University of New South Wales Sydney, Sydney, NSW, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Ilana Ackerman
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sam Adie
- St. George and Sutherland Clinical School, The University of New South Wales Sydney, Sydney, NSW, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Durga Bastiras
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South West Sydney Clinical School, The University of New South Wales Sydney, Sydney, NSW, Australia.,Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Sidhu VS, Graves SE, Buchbinder R, Naylor JM, Pratt NL, de Steiger RS, Chong BH, Ackerman IN, Adie S, Harris A, Hansen A, Cripps M, Lorimer M, Webb S, Clavisi O, Griffith EC, Anandan D, O'Donohue G, Kelly TL, Harris IA. CRISTAL: protocol for a cluster randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study. BMJ Open 2019; 9:e031657. [PMID: 31699735 PMCID: PMC6858170 DOI: 10.1136/bmjopen-2019-031657] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a serious complication following hip arthroplasty (HA) and knee arthroplasty (KA). This study aims to determine whether aspirin is non-inferior to low molecular weight heparin (LMWH) in preventing symptomatic VTE following HA and KA. METHODS AND ANALYSIS This is a cluster randomised, crossover, non-inferiority, trial nested within the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). The clusters will consist of Australian hospitals performing at least 250 HA and/or KA procedures per annum. All adult patients undergoing HA or KA will be included. The intervention will be aspirin, orally, 85-150 mg daily. The comparator will be LMWH (enoxaparin) 40 mg, subcutaneously, daily. Both drugs will commence within 24 hours postoperatively and continue for 35 days after HA and 14 days after KA. Each hospital will be randomised to commence with aspirin or LMWH and then crossover to the alternative treatment after meeting the recruitment target. Data will be collected through the AOANJRR via patient-reported surveys. The primary outcome is symptomatic VTE within 90 days post surgery, verified by AOANJRR staff. The primary analysis will include only patients undergoing elective primary total hip arthroplasty and total knee arthroplasty for osteoarthritis. Secondary outcomes will include symptomatic VTE for all HA and KA (including partial and revision) within 90 days, readmission, reoperation, major bleeding and death within 90 days and reoperation, death and patient-reported pain, function and health status at 6 months. If aspirin is found to be inferior, a cost-effectiveness analysis will be conducted. The study will aim to recruit 15 562 patients from 31 hospitals. ETHICS AND DISSEMINATION Ethics approval has been granted. Trial results will be submitted for publication. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001879257, pre-results) and is endorsed by the Australia and New Zealand Musculoskeletal Clinical Trials Network.
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Affiliation(s)
- Verinder Singh Sidhu
- CRISTAL Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Steven E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Justine Maree Naylor
- CRISTAL Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Nicole L Pratt
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Richard S de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Beng H Chong
- Department of Haematology, Saint George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sam Adie
- Faculty of Medicine, Saint George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Harris
- Monash University Centre for Health Economics, Caufield, Victoria, Australia
| | - Amber Hansen
- CRISTAL Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Maggie Cripps
- CRISTAL Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Steve Webb
- Department of Intensive Care, St John of God Hospital, Subiaco, Western Australia, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Austria
| | | | - Elizabeth C Griffith
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Durga Anandan
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Grace O'Donohue
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Thu-Lan Kelly
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Ian A Harris
- CRISTAL Study Group, Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, University of New South Wales South Western Sydney Clinical School, Liverpool, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
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