Low-dose Aspirin For The Prevention Of VTE After Primary Joint Arthroplasty

Venous thromboembolism(VTE)is a serious complication after joint replacement.Effective drug prevention is one of the most important measures to reduce the incidence of VTE after joint replacement.Although the selection and use of drugs are diverse,the effectiveness,safety and related complications of different anticoagulation strategies are not consistent.Aspirin can effectively prevent VTE after joint arthroplasty,but there is still no consensus on whether low-dose aspirin can be a reasonable prevention strategy.Objectives: To compare the efficacy,safety and related complications of low dose aspirin and low molecular weight heparin in the prevention of venous thromboembolism after primary joint athroplasty,and to explore the feasibility of low dose aspirin in the prevention of venous thromboembolism after joint arthroplasty.Methods:This study reviewed the clinical data of 1326 patients who underwent primary hip and knee arthroplasty in our center from July 2013 to August 2022.After strict implementation of exclusion criteria,a total of 1160 patients(755 patients underwent primary hip arthroplasty and 405 patients underwent primary knee arthroplasty)were included in the study.All patients were given conventional drug prevention of venous thromboembolism within 12-24 hours after operation,and the preventive measures were subcutaneous injection of LMWH(4000IU/d)or oral aspirin(100mg/d),and were divided into two groups according to the use of different drugs.All patients continued to use the drug until 30 days after operation,and the patients were followed up for 90 days.The main outcome measures were symptomatic venous thromboembolism and major bleeding events.The secondary outcome measures were mortality,cardiovascular and cerebrovascular events,infection,postoperative blood transfusion,postoperative hemoglobin decline,incision nonunion reoperation,drainage volume and postoperative hospital stay.The differences of primary and secondary outcomes between the two anticoagulants in patients undergoing primary joint arthroplasty,hip arthroplasty and knee Arthroplasty were statistically analyzed.Results: 1.There were 13 patients(1.5%)with venous thromboembolism in the LMWH group and 6 patients(2%)in the aspirin group(P=0.610).Bleeding events occurred in 3 patients(0.4%)in the LMWH group and 1 patient(0.3%)in the aspirin group(P=1.000).Hemoglobin decreased 27.9±18.7 g/L in LMWH group and22.6±16.6 g/L in aspirin group(P < 0.001).The postoperative drainage volume was195(100,313)ml in the LMWH group and 130(60,240)ml in the aspirin group(P <0.001).The average postoperative hospital stay was 12(8,15)days in the LMWH group and 8(7,13)days in the aspirin group,(P<0.001).There were no significant differences in the other indicators such as death,cardiovascular and cerebrovascular events,infection,blood transfusion,and surgical wound nonunion.2.There were 9patients(1.5%)with venous thromboembolism in LMWH group and 1 patient(0.6%)in aspirin group(P=0.349).There were 2 cases(0.3%)of bleeding events in the LMWH group and 0 cases(0%)in the aspirin group(P=1.000).Hemoglobin decreased by 28.9±18.9g/L in the LMWH group and 25.7±17.7 g/L in the aspirin group(P=0.047).The mean postoperative hospital stay was 11(8,14)days in the LMWH group and 8(7,12)days in the aspirin group(P < 0.001).There were no statistically significant differences in mortality,cardiovascular and cerebrovascular events,infection,blood transfusion,drainage volume,and reoperation for nonunion of the incision between the two groups.3.There were 4 patients(1.5%)with venous thromboembolism in LMWH group and 5 patients(3.7%)in aspirin group(P=0.283).Bleeding events occurred in 1 patient(0.4%)in the LMWH group and 1 patient(0.7%)in the aspirin group(P=1.000).Hemoglobin decreased by 25.8±18.1g/L in the LMWH group and 18.6±14.3g/L in the aspirin group(P<0.001).The postoperative drainage volume was 232(120,365)ml in the LMWH group and 150(90,265)ml in the aspirin group(P < 0.001).The mean postoperative hospital stay was 13(8,15)days in the LMWH group and 8(7,14)days in the aspirin group(P<0.001).There was no significant difference in mortality,cardiovascular and cerebrovascular events,infection,blood transfusion,and reoperation for nonunion of the incision between the two groups.Conclusion:1.Low-dose aspirin is effective and safe for VTE prevention after arthroplasty.2.Compared with LMWH,low-dose aspirin can significantly reduce postoperative blood loss,shorten hospital stay,and reduce postoperative drainage volume after knee arthroplasty.