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Putting patients on aspirin following a knee replacement is a safe, cost-effective alternative to treatment with anticoagulants, according to researchers.
A study of more than 40,000 patients revealed a similar incidence of venous thromboembolism (VTE) or death after total knee arthroplasty (TKA) in patients receiving aspirin and patients receiving anticoagulants.
“Aspirin alone may provide similar protection compared to anticoagulation treatments,” said Brian R. Hallstrom, MD, of the University of Michigan in Ann Arbor.
He and his colleagues compared aspirin to anticoagulants after TKA and detailed their findings in JAMA Surgery.
The researchers evaluated 41,537 patients who underwent TKA and received:
- No pharmacological VTE prophylaxis (n=668; 1.6%)
- Aspirin only (n=12,831; 30.9%)
- Only an anticoagulant (n=22,620; 54.5%)
- Both aspirin and an anticoagulant (n=5418; 13.0%).
Anticoagulants included low-molecular-weight heparin, warfarin, and factor Xa inhibitors.
About 87% of all patients (n=36,113) were also using intermittent pneumatic compression stockings.
Safety and efficacy
The study’s primary outcome was a composite of VTE and death. It occurred in:
- 4.79% (32/668) of patients not on pharmacological prophylaxis
- 1.16% (149/12,831) of patients who received aspirin alone
- 1.42% (321/22,620) of patients on anticoagulation alone
- 1.31% (71/5418) of patients who received both aspirin and anticoagulation.
In a multivariable analysis adjusted for confounding, aspirin was noninferior to the other prophylaxis regimens for the outcome of VTE or death. The adjusted odds ratio was 0.85 (P=0.007).
Bleeding was a secondary outcome of this study, and it occurred in:
- 1.50% (10/668) of patients not on pharmacological prophylaxis
- 0.90% (116/12,831) of patients who received aspirin alone
- 1.14% (258/22,620) of patients who received anticoagulation
- 1.35% (73/5,418) of patients who received both aspirin and anticoagulation.
In an adjusted analysis, aspirin was noninferior to the other prophylaxis regimens for the outcome of bleeding. The adjusted odds ratio was 0.80 (P<0.001).
Other benefits
Aspirin provides other benefits aside from similar safety and efficacy as anticoagulants, according to the researchers.
“Aspirin is easy to take and much less expensive,” Dr. Hallstrom noted. “Patients can get it over the counter for pennies, while the other anticoagulants require monitoring, injections, frequent dose adjustments and are extremely expensive.”
Dr. Hallstrom and his colleagues said the reported cost for a 30-day supply of rivaroxaban is approximately $379 to $450, and the estimated cost of heparin is $450 to $890.
Although warfarin costs a few dollars for a 30-day supply, its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in, the researchers noted.
In contrast, aspirin costs approximately $2 a month.
Dr. Hallstrom and his colleagues did note that, although this study suggests aspirin can prevent VTE as well as anticoagulants, doctors need to consider factors such as a patient’s history of clots, obesity, and ability to mobilize after surgery.
Putting patients on aspirin following a knee replacement is a safe, cost-effective alternative to treatment with anticoagulants, according to researchers.
A study of more than 40,000 patients revealed a similar incidence of venous thromboembolism (VTE) or death after total knee arthroplasty (TKA) in patients receiving aspirin and patients receiving anticoagulants.
“Aspirin alone may provide similar protection compared to anticoagulation treatments,” said Brian R. Hallstrom, MD, of the University of Michigan in Ann Arbor.
He and his colleagues compared aspirin to anticoagulants after TKA and detailed their findings in JAMA Surgery.
The researchers evaluated 41,537 patients who underwent TKA and received:
- No pharmacological VTE prophylaxis (n=668; 1.6%)
- Aspirin only (n=12,831; 30.9%)
- Only an anticoagulant (n=22,620; 54.5%)
- Both aspirin and an anticoagulant (n=5418; 13.0%).
Anticoagulants included low-molecular-weight heparin, warfarin, and factor Xa inhibitors.
About 87% of all patients (n=36,113) were also using intermittent pneumatic compression stockings.
Safety and efficacy
The study’s primary outcome was a composite of VTE and death. It occurred in:
- 4.79% (32/668) of patients not on pharmacological prophylaxis
- 1.16% (149/12,831) of patients who received aspirin alone
- 1.42% (321/22,620) of patients on anticoagulation alone
- 1.31% (71/5418) of patients who received both aspirin and anticoagulation.
In a multivariable analysis adjusted for confounding, aspirin was noninferior to the other prophylaxis regimens for the outcome of VTE or death. The adjusted odds ratio was 0.85 (P=0.007).
Bleeding was a secondary outcome of this study, and it occurred in:
- 1.50% (10/668) of patients not on pharmacological prophylaxis
- 0.90% (116/12,831) of patients who received aspirin alone
- 1.14% (258/22,620) of patients who received anticoagulation
- 1.35% (73/5,418) of patients who received both aspirin and anticoagulation.
In an adjusted analysis, aspirin was noninferior to the other prophylaxis regimens for the outcome of bleeding. The adjusted odds ratio was 0.80 (P<0.001).
Other benefits
Aspirin provides other benefits aside from similar safety and efficacy as anticoagulants, according to the researchers.
“Aspirin is easy to take and much less expensive,” Dr. Hallstrom noted. “Patients can get it over the counter for pennies, while the other anticoagulants require monitoring, injections, frequent dose adjustments and are extremely expensive.”
Dr. Hallstrom and his colleagues said the reported cost for a 30-day supply of rivaroxaban is approximately $379 to $450, and the estimated cost of heparin is $450 to $890.
Although warfarin costs a few dollars for a 30-day supply, its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in, the researchers noted.
In contrast, aspirin costs approximately $2 a month.
Dr. Hallstrom and his colleagues did note that, although this study suggests aspirin can prevent VTE as well as anticoagulants, doctors need to consider factors such as a patient’s history of clots, obesity, and ability to mobilize after surgery.
Putting patients on aspirin following a knee replacement is a safe, cost-effective alternative to treatment with anticoagulants, according to researchers.
A study of more than 40,000 patients revealed a similar incidence of venous thromboembolism (VTE) or death after total knee arthroplasty (TKA) in patients receiving aspirin and patients receiving anticoagulants.
“Aspirin alone may provide similar protection compared to anticoagulation treatments,” said Brian R. Hallstrom, MD, of the University of Michigan in Ann Arbor.
He and his colleagues compared aspirin to anticoagulants after TKA and detailed their findings in JAMA Surgery.
The researchers evaluated 41,537 patients who underwent TKA and received:
- No pharmacological VTE prophylaxis (n=668; 1.6%)
- Aspirin only (n=12,831; 30.9%)
- Only an anticoagulant (n=22,620; 54.5%)
- Both aspirin and an anticoagulant (n=5418; 13.0%).
Anticoagulants included low-molecular-weight heparin, warfarin, and factor Xa inhibitors.
About 87% of all patients (n=36,113) were also using intermittent pneumatic compression stockings.
Safety and efficacy
The study’s primary outcome was a composite of VTE and death. It occurred in:
- 4.79% (32/668) of patients not on pharmacological prophylaxis
- 1.16% (149/12,831) of patients who received aspirin alone
- 1.42% (321/22,620) of patients on anticoagulation alone
- 1.31% (71/5418) of patients who received both aspirin and anticoagulation.
In a multivariable analysis adjusted for confounding, aspirin was noninferior to the other prophylaxis regimens for the outcome of VTE or death. The adjusted odds ratio was 0.85 (P=0.007).
Bleeding was a secondary outcome of this study, and it occurred in:
- 1.50% (10/668) of patients not on pharmacological prophylaxis
- 0.90% (116/12,831) of patients who received aspirin alone
- 1.14% (258/22,620) of patients who received anticoagulation
- 1.35% (73/5,418) of patients who received both aspirin and anticoagulation.
In an adjusted analysis, aspirin was noninferior to the other prophylaxis regimens for the outcome of bleeding. The adjusted odds ratio was 0.80 (P<0.001).
Other benefits
Aspirin provides other benefits aside from similar safety and efficacy as anticoagulants, according to the researchers.
“Aspirin is easy to take and much less expensive,” Dr. Hallstrom noted. “Patients can get it over the counter for pennies, while the other anticoagulants require monitoring, injections, frequent dose adjustments and are extremely expensive.”
Dr. Hallstrom and his colleagues said the reported cost for a 30-day supply of rivaroxaban is approximately $379 to $450, and the estimated cost of heparin is $450 to $890.
Although warfarin costs a few dollars for a 30-day supply, its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in, the researchers noted.
In contrast, aspirin costs approximately $2 a month.
Dr. Hallstrom and his colleagues did note that, although this study suggests aspirin can prevent VTE as well as anticoagulants, doctors need to consider factors such as a patient’s history of clots, obesity, and ability to mobilize after surgery.