Goel R, Fleischman AN, Tan T, Sterbis E, Huang R, Higuera C, Parvizi J, Rothman RH. Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin
versus warfarin.
Bone Joint J 2018;
100-B:68-75. [PMID:
29292343 PMCID:
PMC6424442 DOI:
10.1302/0301-620x.100b1.bjj-2017-0587.r1]
[Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022]
Abstract
Aims
The aims of this study were to compare the efficacy of two agents,
aspirin and warfarin, for the prevention of venous thromboembolism
(VTE) after simultaneous bilateral total knee arthroplasty (SBTKA),
and to elucidate the risk of VTE conferred by this procedure compared
with unilateral TKA (UTKA).
Patients and Methods
A retrospective, multi-institutional study was conducted on 18
951 patients, 3685 who underwent SBTKA and 15 266 who underwent
UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient
was assigned an individualised baseline VTE risk score based on
a system using the Nationwide Inpatient Sample. Symptomatic VTE,
including pulmonary embolism (PE) and deep vein thrombosis (DVT),
were identified in the first 90 days post-operatively. Statistical
analyses were performed with logistic regression accounting for
baseline VTE risk.
Results
The adjusted incidence of PE following SBTKA was 1.0% (95% confidence
interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to
2.4) with warfarin. Similarly, the adjusted incidence of VTE following
SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI
1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by
66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62,
95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk
of PE was 204% higher for patients undergoing SBTKA relative to
those undergoing UTKA. For each ten-point increase in baseline VTE
risk, the risk of PE increased by 25.5% for patients undergoing
SBTKA compared with 10.5% for those undergoing UTKA. Patients with
a history of myocardial infarction or peripheral vascular disease had
the greatest increase in risk from undergoing SBTKA instead of UTKA.
Conclusion
Aspirin is more effective than warfarin for the prevention of
VTE following SBTKA, and serves as the more appropriate agent for
VTE prophylaxis for patients in all risk categories. Furthermore,
patients undergoing SBTKA are at a substantially increased risk
of VTE, even more so for those with significant underlying risk
factors. Patients should be informed about the risks associated
with undergoing SBTKA.
Cite this article: Bone Joint J 2018;100-B(1
Supple A):68–75.
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