For VTE Prevention, Best Anticoagulant Varies by Surgery

Aspirin may be better for lower extremity arthroplasty, other anticoagulants for hip fracture

For VTE Prevention, Best Anticoagulant Varies by Surgery

THURSDAY, July 24, 2014 (HealthDay News) -- Aspirin may be less preferable to other anticoagulants following hip fracture repair, but may be favored after elective knee or hip arthroplasty, according to a meta-analysis published online July 17 in the Journal of Hospital Medicine.

Frank S. Drescher, M.D., from the Geisel School of Medicine at Dartmouth in White River Junction, Vt., and colleagues conducted a systematic literature review to identify randomized trials comparing aspirin to anticoagulants for prevention of venous thromboembolism (VTE) following major lower extremity orthopedic surgery.

The researchers identified eight trials (1,408 participants) that met inclusion criteria. Deep venous thrombosis rates did not differ statistically between aspirin and anticoagulants (relative risk [RR], 1.15; 95 percent confidence interval [CI], 0.68 to 1.96). There was a nonsignificant trend favoring anticoagulation following hip fracture repair (RR, 1.60; 95 percent CI, 0.80 to 3.20; two trials), but not knee or hip arthroplasty (RR, 1.00; 95 percent CI, 0.49 to 2.05; five trials). With aspirin, the risk of bleeding was lower than anticoagulants following hip fracture repair (RR, 0.32; 95 percent CI, 0.13 to 0.77; two trials) and nonsignificantly lower after arthroplasty (RR, 0.63; 95 percent CI, 0.33 to 1.21; five trials).

"Definitive recommendations for or against the use of aspirin instead of anticoagulation for VTE prevention following major orthopedic surgery are not possible," the authors write.

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