Is Aspirin as Effective as the Newer Direct Oral Anticoagulants for Venous Thromboembolism Prophylaxis After Total Hip and Knee Arthroplasty? An Analysis From the National Joint Registry for England,Wales, Northern Ireland,and the Isle of Man |
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| Institution: | 1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom;2. Department of Translational Health Sciences, Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom;3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom;4. National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man;5. Department of Health Sciences, University of York, Heslington, York, United Kingdom;1. Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan;2. Kitakyushu General Hospital, 1-1 Higashijono-machi, Kokurakita-ku, Kita-Kyushu, Fukuoka, 802-8517, Japan;1. Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH;2. Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL;1. Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI;2. Quality Insitute, St. Joseph Mercy Hospital, Ann Arbor, MI |
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| Abstract: | BackgroundFew studies have compared aspirin with direct oral anticoagulants (DOACs) (DOACs = direct thrombin inhibitors and factor Xa inhibitors) for venous thromboembolism (VTE) prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We assessed the efficacy and safety of aspirin compared with DOACs for VTE prophylaxis after THA and TKA using the world's largest joint arthroplasty registry.MethodsWe studied the National Joint Registry linked to English hospital inpatient episodes for 218,650 THA and TKA patients. Patients receiving aspirin were matched separately to patients receiving direct thrombin inhibitors and factor Xa inhibitors using propensity scores. Outcomes assessed at 90 days included VTE, length of stay, and adverse events.ResultsAfter THA, there was a significantly lower risk of VTE associated with the use of direct thrombin inhibitors (0.44%; odds ratio OR], 0.69; 95% confidence interval 95% CI], 0.55-0.87; P = .002) and factor Xa inhibitors (0.37%; OR, 0.63; 95% CI, 0.47-0.85; P = .003) compared with aspirin (0.63%). After THA, direct thrombin inhibitors (coefficient, ?0.37 days; 95% CI, ?0.43 to ?0.31; P < .001) and factor Xa inhibitors (coefficient, ?0.80 days; 95% CI, ?0.87 to ?0.74; P < .001) were associated with a reduced length of stay compared with aspirin. Similar findings for both outcomes were observed after TKA. Compared with aspirin, DOACs were not associated with an increase in the risk of short-term revision surgery, reoperation, major hemorrhage, wound disruption, surgical site infection, and mortality.ConclusionAfter THA and TKA, DOACs were associated with a reduced risk of VTE compared with aspirin. DOACs were associated with a reduced length of stay, and DOACs were not associated with an increase in the risk of further surgery, wound problems, bleeding complications, or mortality compared with aspirin. |
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| Keywords: | hip arthroplasty knee arthroplasty outcomes venous thromboembolism anticoagulation |
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