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Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin versus warfarin.

Abstract 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).
PMID
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Authors

Mayor MeshTerms

Arthroplasty, Replacement, Knee

Keywords

Aspirin

Bilateral

Knee

Total Knee Arthroplasty

Venous thromboembolism

Journal Title the bone & joint journal
Publication Year Start




 
PMID- 29292343
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 1 Supple A
DP  - 2018 Jan
TI  - Venous thromboembolic prophylaxis after simultaneous bilateral total knee
      arthroplasty: aspirin versus warfarin.
PG  - 68-75
LID - 10.1302/0301-620X.100B1.BJJ-2017-0587.R1 [doi]
AB  - 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.
CI  - (c)2018 The British Editorial Society of Bone and Joint Surgery.
FAU - Goel, R
AU  - Goel R
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
FAU - Fleischman, A N
AU  - Fleischman AN
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
FAU - Tan, T
AU  - Tan T
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
FAU - Sterbis, E
AU  - Sterbis E
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
FAU - Huang, R
AU  - Huang R
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
FAU - Higuera, C
AU  - Higuera C
AD  - Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
FAU - Parvizi, J
AU  - Parvizi J
AD  - Rothman Institute, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
FAU - Rothman, R H
AU  - Rothman RH
AD  - Rothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite
      1000, Philadelphia, PA 19107, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - R16CO5Y76E (Aspirin)
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - *Arthroplasty, Replacement, Knee/methods
MH  - Aspirin/*therapeutic use
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Postoperative Complications/epidemiology/*prevention & control
MH  - Pulmonary Embolism/epidemiology/etiology/prevention & control
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Venous Thromboembolism/epidemiology/etiology/*prevention & control
MH  - Venous Thrombosis/epidemiology/etiology/prevention & control
MH  - Warfarin/*therapeutic use
OTO - NOTNLM
OT  - Aspirin
OT  - Bilateral
OT  - Knee
OT  - Total Knee Arthroplasty
OT  - Venous thromboembolism
EDAT- 2018/01/03 06:00
MHDA- 2018/01/05 06:00
CRDT- 2018/01/03 06:00
PHST- 2017/05/10 00:00 [received]
PHST- 2017/07/10 00:00 [accepted]
PHST- 2018/01/03 06:00 [entrez]
PHST- 2018/01/03 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - 100-B/1_Supple_A/68 [pii]
AID - 10.1302/0301-620X.100B1.BJJ-2017-0587.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Jan;100-B(1 Supple A):68-75. doi:
      10.1302/0301-620X.100B1.BJJ-2017-0587.R1.