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Núñez JH, Moreira F, Escudero-Cisneros B, Martínez-Peña J, Bosch-García D, Angles F, Guerra-Farfán E. [Translated article] Risk of venous thromboembolism in thromboprophylaxis between aspirin and low molecular weight heparins after total hip arthroplasty or total knee arthroplasty: Systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T409-T421. [PMID: 38325570 DOI: 10.1016/j.recot.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of aspirin versus low molecular weight heparins (LMWH) for the prophylaxis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing total knee arthroplasty (TKA) and/or total hip arthroplasty (THA). MATERIALS AND METHODS Systematic review and meta-analysis. Sixteen studies were selected. The risk of VTE, DVT and PE were analysed. Mortality, risk of bleeding and surgical wound complications was also analysed. RESULTS 248,461 patients were included. 176,406 patients with thromboprophylaxis with LMWH and 72,055 patients with aspirin thromboprophylaxis. There were no significant differences in the risk of VTE (OR=0.93; 95% CI: 0.69-1.26; p=0.64), DVT (OR=0.72; 95% CI: 0.43-1.20; p=0.21) or PE (OR=1.13; 95% CI: 0.86-1.49; p=0.38) between both groups. No significant differences were found in mortality (p=0.30), bleeding (p=0.22), or complications in the surgical wound (p=0.85) between both groups. These same findings were found in the sub-analysis of only randomised clinical trials (p>0.05). CONCLUSIONS No increased risk of PE, DVT, or VTE was found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis. There was also no greater mortality, greater bleeding, or greater complications in the surgical wound found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis.
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Affiliation(s)
- J H Núñez
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain; Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022 Barcelona, Spain.
| | - F Moreira
- Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022 Barcelona, Spain
| | - B Escudero-Cisneros
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain
| | - J Martínez-Peña
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain
| | - D Bosch-García
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain
| | - F Angles
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Plaça del Doctor Robert, 5, 08221 Terrassa, Barcelona, Spain
| | - E Guerra-Farfán
- Artro-Esport, Centro Médico Teknon, Carrer de Vilana, 12, 08022 Barcelona, Spain
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Núñez JH, Moreira F, Escudero-Cisneros B, Martínez-Peña J, Bosch-García D, Anglès F, Guerra-Farfán E. Risk of venous thromboembolism in thromboprophylaxis between aspirin and low molecular weight heparins after total hip arthroplasty or total knee arthroplasty: Systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:409-421. [PMID: 37544408 DOI: 10.1016/j.recot.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy of aspirin versus low molecular weight heparins (LMWH) for the prophylaxis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing total knee arthroplasty (TKA) and/or total hip arthroplasty (THA). MATERIALS AND METHODS Systematic review and meta-analysis. Sixteen studies were selected. The risk of VTE, DVT and PE were analyzed. Mortality, risk of bleeding and surgical wound complications was also analyzed. RESULTS 248,461 patients were included. 176,406 patients with thromboprophylaxis with LMWH and 72,055 patients with aspirin thromboprophylaxis. There were no significant differences in the risk of VTE (OR = 0.93; 95% CI: 0.69-1.26; P = .64), DVT (OR = 0.72; 95% CI: 0.43-1.20; P = .21) or PE (OR = 1.13; 95% CI: 0.86-1.49; P = .38) between both groups. No significant differences were found in mortality (P = .30), bleeding (P = .22), or complications in the surgical wound (P = .85) between both groups. These same findings were found in the sub-analysis of only randomized clinical trials (P>.05). CONCLUSIONS No increased risk of PE, DVT, or VTE was found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis. There was also no greater mortality, greater bleeding, or greater complications in the surgical wound found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis.
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Affiliation(s)
- Jorge H Núñez
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Terrassa, Barcelona, España; Artro-Esport, Centro Médico Teknon, Terrassa, Barcelona, España.
| | - Felipe Moreira
- Artro-Esport, Centro Médico Teknon, Terrassa, Barcelona, España
| | - Berta Escudero-Cisneros
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Terrassa, Barcelona, España
| | - Judith Martínez-Peña
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Terrassa, Barcelona, España
| | - David Bosch-García
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Terrassa, Barcelona, España
| | - Francesc Anglès
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario de Mutua Terrassa, Terrassa, Barcelona, España
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Zheng X, Nong L, Song Y, Han L, Zhang Y, Yin Q, Bian Y. Comparison of efficacy and safety between aspirin and oral anticoagulants for venous thromboembolism prophylaxis after major orthopaedic surgery: a meta-analysis of randomized clinical trials. Front Pharmacol 2024; 14:1326224. [PMID: 38259284 PMCID: PMC10800895 DOI: 10.3389/fphar.2023.1326224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Background: venous thromboembolism (VTE) is one of the most common complications after major orthopaedic surgery. Recent studies have suggested that aspirin may also be effective in preventing VTE, but it is still controversial whether it can be routinely used. Objectives: To compare the efficacy and safety of aspirin against oral anticoagulants in the prevention of VTE following total hip arthroplasty (THA), total knee arthroplasty (TKA) or hip fracture surgery (HFS). Methods: Relevant publications have been obtained using electronic search databases such as PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials. gov. from inception to 20 July 2023. Only RCTs evaluating the efficacy and safety of aspirin compared with oral anticoagulants undergoing major orthopaedic surgery were included in the meta-analysis. The primary outcome reported was any VTE event (including deep vein thrombosis (DVT) and pulmonary embolism (PE)). Secondary outcomes included mortality, major bleeding (including gastrointestinal bleed, cerebrovascular hemorrhage, or any bleeding requiring a return to the theater), minor bleeding (ecchymosis, epistaxis, hematuria), and wound complications. The risk of bias for all included studies was assessed according to the Cochrane Collaboration's tool. Results: After screening 974 studies, 12 randomized clinical trials (RCTs) were included, involving 5,088 participants, including 2,540 participants in aspirin, 2,205 participants in rivaroxaban, and 323 participants in warfarin. Aspirin was found to be less effective than oral anticoagulants in thromboprophylaxis after major orthopedic surgery (RR = 1.206, 95% CI 1.053-1.383). After subgroup analysis according to the type of oral anticoagulant, the results showed that aspirin was similar to rivaroxaban and inferior to warfarin. Considering that the studies in the warfarin group were all conducted before 2000, our results need to be further confirmed. In addition, the aspirin group had a higher risk of VTE than the control group in other subgroups, including a follow-up time of ≤3 months, type of procedure as TKA, high-dose aspirin (≥650 mg qd), and no combined use of mechanical prophylaxis. In terms of safety events, aspirin did not show significant differences in major bleeding (RR = 0.952, 95% CI 0.499-1.815), all-cause mortality (RR = 1.208, 95% CI 0.459-3.177), and wound-related events (RR = 0.618, 95% CI 0.333-1.145) compared with oral anticoagulants, and aspirin was associated with a reduction in the risk of minor bleeding (RR = 0.685, 95% CI 0.552-0.850) events and total bleeding (RR = 0.726, 95% CI 0.590-0.892). Conclusion: Aspirin reduces bleeding risk after major orthopedic surgery compared with oral anticoagulants, but may sacrifice VTE prevention to some extent. Updated evidence is needed to analyze the thromboprophylaxis effects of aspirin in patients undergoing major orthopedic surgery. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463481, identifier CRD42023463481.
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Affiliation(s)
- Xingyue Zheng
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Nong
- Department of Pharmacy, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yujie Song
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Lizhu Han
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Qinan Yin
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Yuan Bian
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
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Liu HZ, Liang J, Hu AX. The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e35602. [PMID: 37861503 PMCID: PMC10589573 DOI: 10.1097/md.0000000000035602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Major orthopedic surgery, including hip and knee replacement and lower extremity trauma fractures surgery, is associated with a high risk of venous thromboembolism (VTE), especially proximal deep vein thrombosis (DVT), and pulmonary embolism (PE), and is linked with high morbidity and mortality rates. Chemical anticoagulation is routinely used to prevent VTE, with previous meta-analyses reporting on the efficacy and safety of aspirin and other anticoagulants, however, opinions are divided. In the past 2 years, several large randomized controlled trials have been published, therefore, we reanalyzed aspirin efficacy and safety when compared with other anticoagulants in preventing VTE in major orthopedic surgery. METHODS Using PubMed, The Cochrane Library, Embase, and Web of Science databases, we conducted a RCT search in August 2023. The main outcomes included VTE, proximal DVT or PE. Additional outcomes included bleeding events, wound complications, wound infections, blood transfusions, and death events. RESULTS In total, 17 eligible articles, involving 29,522 patients (15,253 aspirin vs 14,269 other anticoagulant cases), were included. Primary outcomes showed that VTE incidence was more high in the aspirin group when compared with other anticoagulants (risk ratio [RR] = 1.45, 95% confidence interval [CI] = 1.18-1.77, P = .0004) and proximal in the aspirin group the DVT and/or PE incidence was significantly higher in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02-1.39, P = .03). No significant secondary outcome differences were identified in the aspirin group when compared with other anticoagulants (bleeding events [RR] = 0.83, 95% CI = 0.63-1.10, P = .20); wound complications (RR = 0.45, 95% CI = 0.20-1.04, P = .06); wound infection (RR = 1.08, 95% CI = 0.85-1.38, P = .53); blood transfusion events (RR = 1.00, 95% CI = 0.84-1.19, P = 1.00) and death events (RR = 1.11, 95% CI = 0.78-1.57, P = .55). CONCLUSIONS Our updated meta-analysis showed that aspirin was inferior to when compared with other anticoagulants in VTE-related orthopedic major surgery, including proximal DVT and/or PE, and was more likely to form VTE. No differences between groups were identified for bleeding, wound complications, wound infections, transfusion, or death events.
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Affiliation(s)
- Heng-Zhi Liu
- Department of Orthopaedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Orthopaedics, Yichang Central People’s Hospital, Yichang, China
| | - Jie Liang
- Department of Orthopaedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Orthopaedics, Yichang Central People’s Hospital, Yichang, China
| | - Ai-Xin Hu
- Department of Orthopaedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China
- Department of Orthopaedics, Yichang Central People’s Hospital, Yichang, China
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Zhou LB, Wang CC, Zhang LT, Wu T, Zhang GQ. Effectiveness of different antithrombotic agents in combination with tranexamic acid for venous thromboembolism prophylaxis and blood management after total knee replacement: a prospective randomized study. BMC Musculoskelet Disord 2023; 24:5. [PMID: 36600227 DOI: 10.1186/s12891-022-06117-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has been widely applied in total knee arthroplasty (TKA) to significantly reduce perioperative blood loss and improve knee function recovery in patients after surgery. The choice of antithrombotic agents for venous thromboembolism (VTE) prevention after TKA is controversial. Therefore, this study aimed to compare the effects of different antithrombotic agents on patients after primary unilateral TKA in the context of applied TXA. METHODS A total of 180 patients undergoing primary unilateral TKA from October 2020 to December 2021 were included in this study. All patients were given an intraoperative drip of 60 mg/kg TXA. Thereafter, patients were divided into three groups (n = 60 each). Baseline data were comparable among the three groups. The average follow-up time was 3.02 ± 0.09 months. Group 1 enrolled patients receiving oral rivaroxaban (RA) at 10 mg, Group 2 included patients who received subcutaneous Dalteparin sodium at 2500 IU, while Group 3 included patients taking oral aspirin (ASA) at 100 mg. Patients in all the three groups received treatment once a day for 30 days at 12 h postoperatively. The primary outcomes in this study were post-treatment drainage volume and thrombotic complication rate. The secondary outcomes included hematologic parameters, transfusion rate, intraoperative blood loss, total blood loss (TBL), and bleeding complication rate. RESULTS The average drainage volume after treatment was significantly lower in Group 3 than in Group 1 and Group 2 (205.2 ± 69.0 vs 243.4 ± 72.5 vs 295.4 ± 72.5 ml, P < 0.001), and there was a significant difference between Group 1 and Group 2 (243.4 ± 72.5 mL vs 295.4 ± 72.5 mL, P < 0.001). The blood transfusion rate of Group 2 dramatically increased compared with Group 1 and Group 3 (20.0% vs 6.7% vs 5.0%, P = 0.01). The bleeding complication rate in Group 1 apparently increased relative to Group 2 and Group 3 (26.7% vs 10.0% vs 8.3%, P = 0.008). Besides, there was no significant difference in the thrombotic complication rate among the three groups. CONCLUSION Under the background of TXA application, ASA, RA, and Dalteparin sodium were all effective on preventing VTE after TKA. In addition, ASA effectively reduced post-treatment Hemoglobin (Hb) loss, drainage volume, TBL, transfusion rate, and bleeding complications compared with RA and Dalteparin sodium. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2200060169). Date of Registration: 21/05/2022.
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Affiliation(s)
- Li-Bo Zhou
- Department of Graduate School, Qinghai University, No. 251 Ningda Road, Chengbei District, Xining, 810016, Qinghai Province, China
| | - Chao-Chao Wang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Lan-Tao Zhang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Tao Wu
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Guo-Qiu Zhang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China.
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Singjie LC, Halomoan R, Saleh I, Sumargono E, Kholinne E. Clinical effectiveness and safety of aspirin and other anticoagulants for venous thromboembolism prophylaxis after major orthopedic surgery: a systematic review and meta-analysis of randomized clinical trials. EFORT Open Rev 2022; 7:792-799. [PMID: 36541528 PMCID: PMC9880907 DOI: 10.1530/eor-22-0053] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Patients undergoing major orthopedic surgeries, such as total hip replacement (THR), total knee replacement (TKR), and trauma surgery, are at an elevated risk of venous thromboembolism (VTE), causing significant morbidity and mortality. Previous studies have investigated aspirin as a thromboprophylactic agent for arthroplasty, besides trauma surgery. Therefore, we sought to analyze the efficacy of aspirin compared to that of other anticoagulants for VTE prophylaxis in patients undergoing major orthopedic surgeries. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered with the PROSPERO register. Randomized controlled trials that investigated the use of aspirin for thromboprophylaxis in major orthopedic lower limb surgeries were included and analyzed. Quality analysis of the literature and level of evidence were assessed. The primary clinical outcome was VTE. Secondary clinical outcomes included mortality, bleeding events, and wound complications. Results Eight high-quality studies with level 2 evidence (published within 2006-2021) were included, comprising 6220 patients. The incidence of VTE with aspirin was not found to be more significant than other anticoagulants (risk ratio (RR) = 1.18, 95% CI: 0.89-1.58, P = 0.25). Regarding secondary outcomes, there were no significant differences between aspirin and other anticoagulants (mortality (RR = 1.40, 95% CI: 0.27-7.23, P = 0.69), bleeding events (RR = 0.89, 95% CI: 0.57-1.39, P = 0.61), or wound complications (RR = 0.64, 95% CI: 0.30-1.35, P = 0.24)). Conclusion The current meta-analysis did not show any difference between aspirin and other anticoagulants as thromboprophylactic agents in preventing VTE in patients who underwent major orthopedic surgeries.
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Affiliation(s)
- Leonard Christianto Singjie
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia,Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Reynaldo Halomoan
- Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Ifran Saleh
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia,Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | | | - Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia,Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia,Correspondence should be addressed to E Kholinne;
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Le G, Yang C, Zhang M, Xi L, Luo H, Tang J, Zhao J. Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty: A protocol for meta-analysis. Medicine (Baltimore) 2020; 99:e23055. [PMID: 33285683 PMCID: PMC7717737 DOI: 10.1097/md.0000000000023055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The purpose of this meta-analysis is to compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) following either total knee arthroplasty or total hip arthroplasty. METHODS A comprehensive literature search of several electronic databases (PubMed, Embase, and Web of Science) was conducted to identify relevant studies. Outcomes of interest included VTE rate, deep vein thrombosis (DVT) rate, pulmonary embolism rate, major bleeding events, mortality rate, blood transfusion, and wound complication. Risk ratio (RR) with 95% confidence intervals (95%CIs) were calculated using a fixed-effects model or random-effects model. RESULTS A total of 8 studies with 97,677 patients met the inclusion criteria and were included in this meta-analysis. Compared with rivaroxaban, aspirin had a significantly higher incidence of DVT (RR = 1.48, 95%CI: 1.27, 1.72; P < .001), and decreased risk of blood transfusion (RR = 0.94, 95%CI: 0.93, 0.94; P < .001). However, there were no significant differences between the 2 drugs in terms of total VTE rate (RR = 1.39%, 95%CI: 0.94, 2.05; P = .101), pulmonary embolism rate (RR = 1.64, 95%CI: 0.92, 2.92; P = .094), mortality rate (RR = 1.13, 95%CI: 0.15, 8.27; P = .907), major bleeding (RR = 1.00, 95%CI: 0.44, 2.27; P = .995), and wound complication rate (RR = 0.37, 95%CI: 0.07, 1.87; P = .229). CONCLUSION Our results suggested that aspirin and rivaroxaban offered similar effect in the prevention of VTE after total knee arthroplasty or total hip arthroplasty. However, rivaroxaban seemed to have better effect than aspirin in reducing the risk of DVT, and aspirin was safer than rivaroxaban in decreasing the blood transfusion rate.
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Affiliation(s)
- Guoping Le
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Chengzhi Yang
- Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Ming Zhang
- Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Licheng Xi
- Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Hanwen Luo
- Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Jingli Tang
- Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, China
| | - Jinmin Zhao
- Division of Traumatic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning
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Sakka BI, Shiinoki A, Morikawa L, Mathews K, Andrews S, Nakasone C. Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty. Knee 2020; 27:1406-1410. [PMID: 33010754 DOI: 10.1016/j.knee.2020.07.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/27/2020] [Accepted: 07/31/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) demonstrates excellent functional outcomes and patient satisfaction with low complication rates for single compartment knee arthritis. For patients with bilateral symptoms, single-stage bilateral UKA (SSBUKA) provides an alternative to staged procedures but may risk increased blood loss and systemic complications. Therefore, the purpose of this study is to compare 90-day postoperative complications between unilateral UKA and SSBUKA without exclusion for comorbidities. METHODS A retrospective review was completed for 555 consecutive patients having undergone UKA (317 unilateral and 238 bilateral). Data collection included patient demographics and 90-day complications. Independent t-tests (continuous) and Fishers' Exact tests (nominal) were performed to determine differences between unilateral UKA and SSBUKA patients. RESULTS The SSBUKA group had more male patients than the unilateral group (51.3% and 43.8%, respectively). There was no difference in age, body mass index or comorbidity classification. More SSBUKA patients experienced nausea than unilateral patients (17.6% and 11.0%), however, no significant differences were observed in the overall incidence of wound or systemic complications, and no transfusions were required. Significantly more unilateral patients (96.2%) were discharged home compared to SSBUKA (63.0%) (p < 0.001). Two SSBUKA (1.7%) and two unilateral UKA (0.6%) patients required readmission within 90-days with systemic complications. CONCLUSIONS SSBUKA did not increase the risk of early postoperative systemic or wound complications, when performed in all patients with symptomatic disease without exclusion criteria as compared to patients undergoing unilateral UKA. Therefore, SSBUKA can safely be performed on the majority of patients who present to experienced high volume community hospitals.
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Affiliation(s)
- Brandan I Sakka
- John A. Burns School of Medicine, 651 Ilalo Street, Honolulu, HI 96813, USA
| | - Aaron Shiinoki
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Landon Morikawa
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Kristin Mathews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA
| | - Samantha Andrews
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA.
| | - Cass Nakasone
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI 96813, USA; University of Hawai'i, Department of Surgery, 1356 Lusitana Street, Honolulu, HI 96813, USA
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Al-Dadah O, Hing C. Editorial. Knee 2019; 26:283-284. [PMID: 31023474 DOI: 10.1016/j.knee.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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