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Should we use dabigatran or aspirin thromboprophylaxis in total hip and knee arthroplasty? A natural experiment.

ABSTRACT: Background:Despite long clinical experience some authorities recommend against the use of aspirin for perioperative VTE prophylaxis and favour alternatives such as dabigatran. A change from Dabigatran to an Aspirin based protocol in a British district general hospital created the conditions of a natural experiment. Methods:We conducted a single centre, retrospective study of 6-months using a dabigatran based protocol (THA n?=?191, TKA n?=?155) and 6-months using and aspirin based protocol (THA n?=?165, TKA n?=?136). Outcomes addressed include: VTE used, VTE events within 90-days, 30-day return to theatre (RTT) rates, and 90-day mortality. Results:Pre-intervention, the dabigatran prescription rate was 73% (n?=?139) and 78% (n?=?123) with aspirin prescription post-intervention in 67% (n?=?110) and 70% (n?=?90) for THA and TKA respectively. We found a similar VTE rate when comparing dabigatran and aspirin groups for THA (2.2% vs. 0%, p?=?0.17) and TKA (0.64% vs. 0%, p?=?0.32). Similarly, no difference in the RTT rate was seen for THA (0.7% vs.2.7%, p?=?0.23) or TKA (1.6% vs. 3.2%, p?=?0.38). Conclusion:No significant differences in safety were found comparing aspirin to dabigatran for VTE prophylaxis for lower limb arthroplasty which, has not been previously reported and represents significant cost saving implications.

SUBMITTER: McHale S

PROVIDER: S-EPMC6806636 | biostudies-literature | 2019 Nov-Dec

REPOSITORIES: biostudies-literature

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Should we use dabigatran or aspirin thromboprophylaxis in total hip and knee arthroplasty? A natural experiment.

McHale Stephen S Williams Mark M O'Mahony Canice C Hockings Michael M

Journal of orthopaedics 20190527 6

<h4>Background</h4>Despite long clinical experience some authorities recommend against the use of aspirin for perioperative VTE prophylaxis and favour alternatives such as dabigatran. A change from Dabigatran to an Aspirin based protocol in a British district general hospital created the conditions of a natural experiment.<h4>Methods</h4>We conducted a single centre, retrospective study of 6-months using a dabigatran based protocol (THA n = 191, TKA n = 155) and 6-months using and aspirin based ...[more]

PMID: 31660024

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Project description:ObjectiveTo compare the blood loss, transfusion rates and complications between the aspirin and non-aspirin group in unilateral and bilateral total knee arthroplasties (TKAs) with a nested case-control design.MethodsThe present study retrospectively selected TKA cases from the Joint Arthroplasty Database at the Peking Union Medical College Hospital from January 2014 to December 2019 following strict inclusion and exclusion criteria, and divided them into the aspirin and non-aspirin group based on the use of aspirin preoperatively. Bleeding was measured by blood loss, transfusion rate, drainage volume, hemoglobin (HGB) and hematocrit (HCT), while complications (cardiovascular events, venous thromboembolism events, cerebrovascular events and wound events) were compared between the groups. Student's unpaired t-test and Mann-Whitney U-test were used to compare the differences of continuous variables between the two groups while chi-square test and Fisher's exact test were applied in categorical variables.ResultsA total of 560 patients with unilateral TKA and 285 patients with bilateral TKA were extracted. Among these, 280 patients used aspirin preoperatively. No other differences were found in demographic and surgical characteristics between the two groups except for the proportion of coronary artery diseases (P < 0.001). For primary outcomes, there was no significant higher blood loss and transfusion rate in the aspirin group, while the drainage of aspirin group was higher than the control group in bilateral TKAs (P = 0.043). The HGB and HCT of the aspirin group was significant lower in both unilateral and bilateral TKAs at POD5 (P < 0.05). For complications, there was a lower vascular related complication rate in aspirin group after unilateral TKAs (P = 0.040), but the wound event rate in aspirin group was higher than the control group (P = 0.049).ConclusionsPreoperative use of aspirin could prevent vascular related events during the perioperative period of TKA. However, it might also increase the risk of bleeding and wound complications.

Project description:ObjectivesFor the non-vitamin-K oral anticoagulants, data on bleeding when used for 42 days as thromboprophylaxis after total knee arthroplasty (TKA) are scarce. This pilot study assessed feasibility of a multicentre randomised clinical trial to evaluate major and clinically relevant non-major bleeding during 42-day use of dabigatran, nadroparin and rivaroxaban after TKA.Patients and methodsIn 70 weeks, between July 2012 and November 2013, 198 TKA patients were screened for eligibility in the Martini Hospital (Groningen, the Netherlands). Patients were randomly assigned to dabigatran (n=45), nadroparin (n=45) or rivaroxaban (n=48). The primary outcome was the combined endpoint of major bleeding and clinically relevant non-major bleeding. Secondary endpoints of this study were the occurrence of clinical venous thromboembolism (VTE) (pulmonary embolism or deep venous thrombosis), compliance, duration of hospital stay, rehospitalisation, adverse events and Knee Injury and Osteoarthritis Outcome Score (KOOS).ResultsThe primary outcome was observed in 33.3% (95% CI 20.0% to 49.0%), 24.4% (95% CI 12.9% to 39.5%) and 27.1% (95% CI 15.3% to 41.8%) of patients who received dabigatran, nadroparin or rivaroxaban, respectively (p=0.67). Major bleeding was found in two patients who received nadroparin (p=0.21). Clinically relevant non-major bleeding was observed in 33.3% (95% CI 20.0% to 49.0%), 22.2% (95% CI 11.2% to 37.1%) and 27.1% (95% CI 15.3% to 41.8%) for dabigatran, nadroparin and rivaroxaban, respectively (p=0.51). Wound haematoma was the most observed bleeding event. VTE was found in one patient who received dabigatran (p=0.65). The presurgery and postsurgery KOOS qQuestionnaires were available for 32 (71%), 35 (77%) and 35 (73%) patients for dabigatran, nadroparin and rivaroxaban, respectively. KOOS was highly variable, and no significant difference between treatment groups in mean improvement was observed.ConclusionsA multicentre clinical trial may be feasible. However, investments will be substantial. No differences in major and clinically relevant non-major bleeding events were found between dabigatran, nadroparin and rivaroxaban during 42 days after TKA. KOOS may not be suitable to detect functional loss due to bleeding.Trial registration numberNCT01431456.

Dataset Information

Should we use dabigatran or aspirin thromboprophylaxis in total hip and knee arthroplasty? A natural experiment.

Publications

Should we use dabigatran or aspirin thromboprophylaxis in total hip and knee arthroplasty? A natural experiment.

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