Is Aspirin an Effective Way to Prevent VTE in Hip Fracture Patients?
Dr. Emanuele Chisari and Dr. Javad Parvizi answer ICJR’s questions about their study comparing outcomes in femoral neck fracture patients who received either aspirin or a more potent anticoagulant following total hip arthroplasty or hemiarthroplasty.
ICJR: What question did you and your co-authors want to answer with this study?
Emanuele Chisari, MD: Aspirin is widely used as chemoprophylaxis for venous thromboembolism (VTE) in patients undergoing total hip arthroplasty (THA) for end-stage osteoarthritis. It’s safe, effective, and inexpensive. We wanted to know if aspirin is also a viable option for prevention of VTE in patients undergoing THA or hemiarthroplasty for femoral neck fracture.
ICJR: What did you conclude?
Dr. Chisari: We found that aspirin is an acceptable chemoprophylactic option in femoral neck fracture patients. It was non-inferior to more potent anticoagulants, even when adjusting for confounding factors
ICJR: How did you reach your conclusions? What was your study cohort and what did you find with your analysis?
Dr. Chisari: We designed a retrospective multicenter study involving 3 large academic centers: The Rothman Orthopaedic Institute, Cleveland Clinic, and Columbia University. We included femoral neck fracture patients with a history of hemiarthroplasty or THA performed between 2008 and 2018. This gave us a total of 1441 patients, 454 of whom had received aspirin and 687 of whom had received a more potent anticoagulant. We risk-stratified our patients based on a validated risk score for VTE, and we used multivariable regression modeling to adjust for confounding factors. The primary outcome was development of VTE (deep vein thrombosis or pulmonary embolism) within 90 days postoperatively.
ICJR: Why is this significant for clinical practice?
Javad Parvizi, MD, FRCS: As mentioned above, many surgeons are currently using aspirin as VTE chemoprophylaxis after THA. However, its use in femoral neck fracture patients has been a matter of debate.
In our study, fewer than 2% of the patients who received aspirin after THA or hemiarthroplasty developed deep vein thrombosis or a pulmonary embolism. By comparison, nearly 7% of patients in the anticoagulant medication group developed these complications. Aspirin was found to be independently associated with a lower VTE risk after multivariable analysis.
Patients in the aspirin group also had a lower 90-day readmission rate, a lower mortality rate, fewer periprosthetic joint infections, and fewer postoperative transfusions.
With these findings, we can recommend the use of aspirin as chemoprophylaxis in the femoral neck fracture population, as our study found it to be a safe and effective option for these patients.
About the Experts
Emanuele Chisari, MD, is a Research Fellow at The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, and a PhD student at the University of Oxford in the United Kingdom.
Javad Parvizi, MD, FRCSC, is an orthopaedic surgeon and the Director of Clinical Research at The Rothman Orthopaedic Institute. He is also the James Edwards Professor Chair of Orthopaedics at Thomas Jefferson University, Philadelphia, Pennsylvania.
Disclosures: Dr. Chisari and Dr. Parvizi have no disclosures relevant to this article.
Chisari E, Shah RP, Levitsky M, Piuzzi NS, Higera Rueda CA, Santana DC, Satwah S, Tan T, Parvizi J. Aspirin is a good prophylaxis option for venous thromboembolism in patients with femoral neck fracture undergoing arthroplasty (Paper 209). Presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons, August 31-September 3, San Diego, California.