Little Impact of Antiplatelet Agents on Venous Thromboembolism after Hip Fracture Surgery

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS

Role for aspirin after total hip replacement?

Background: Deep vein thrombosis can occur in up to 60% of patients following major orthopaedic surgery. Routine prophylaxis against thromobembolic complications is now the standard of care in this setting. Pharmacological agents used include unfractionated heparin, low molecular weight heparin, factor Xa inhibitors (fondaparinux), vitamin K antagonists and aspirin. Aim: To review the evidence and discuss the use of aspirin as thromboprophylaxis following elective total hip replacement, and consider its use in adult patients who refuse low molecular weight heparin. Method: A literature search was conducted to identify clinical studies, meta-analyses and clinical practice guidelines evaluating the use of aspirin as thromboprophylaxis following elective total hip replacement. Results: No large trials of acceptable quality which specifically compared aspirin with placebo following total hip replacement were identified. Clinical practice guidelines, meta-analyses and one clinical trial assessed aspirin against placebo or other agents used in thromboprophylaxis in major orthopaedic surgery, including elective total hip replacement. Conclusion: There is insufficient evidence to support the use of aspirin alone as thromboprophylaxis following elective total hip replacement.link_to_subscribed_fulltex