Aspirin Shown as Effective as Routine Coumadin in Preventing Thrombosis Following Total Knee Arthroplasty

Mark W. Gesell, MD
Hospital for Special Surgery

Alejandro Gonzalez Della Valle, MD
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College

Sergio Bartolomé García, MD
Hospital for Special Surgery

Stavros G. Memtsoudis, MD, PhD
Stavros G. Memtsoudis, MD, PhD
Attending Anesthesiologist, Hospital for Special Surgery
Clinical Professor of Anesthesiology, Weill Cornell Medical College
Yan Ma, PhD
Yan Ma, PhD
Assistant Scientist, Hospital for Special Surgery
Assistant Professor of Biostatistics, Department of Public Health, Weill Cornell Medical College
Steven B. Haas, MD
Steven B. Haas, MD
Chief of Knee Service, Hospital for Special Surgery
Attending Orthopedic Surgeon, Hospital for Special Surgery
Eduardo A. Salvati, MD
Eduardo A. Salvati, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Clinical Professor of Surgery (Orthopaedics), Hospital for Special Surgery

Like many surgeries, knee replacement carries a risk of patients developing a reaction after the procedure involving life-threatening blood clots. This reaction is known as venous thromboembolism, or VTE.  

Because HSS performs more knee replacements than any other hospital, HSS is especially empowered to help refine and innovate newer and safer VTE prevention protocols, and document their effectiveness.

Now, a collaboration of HSS surgeons and anesthesiologists has shown that aspirin can be as effective a medication as the blood-thinning drug Coumadin when used in a multimodal program to prevent VTE in patients having total knee arthroplasty (TKA).

Coumadin is a powerful drug, with potential side effects. In the past, Coumadin had been routinely prescribed to all joint replacement patients as part of VTE prevention. This large study demonstrates that aspirin can be safely used – instead of the routinely prescribed Coumadin –  as part of a VTE prevention program for patients who have a low thromboembolic risk.

The multi-part program includes determining a patient’s level of VTE risk before surgery and using regional anesthesia during the procedure. Then, after surgery, the program calls for use of a mechanical, circulation-stimulating “boot” device, as well as practicing early mobilization by getting patients up and out of bed as soon as possible.

2,032 Patients Studied

The team compared two groups of patients undergoing TKA. Both groups received a comprehensive VTE prevention program. However, different medicines were used as the chemical part of the program in each group.

In one group of 1,016 consecutive patients, all the patients received routine Coumadin as the medicine. In the other group of 1,016 consecutive patients, aspirin was used in 67% of patients and Coumadin was used for 33% of the patients, who had either high risk, or who were on Coumadin before surgery.

Aspirin Works

Comparing the two groups, there was no significant difference in rates of VTE. The two groups showed no difference in pulmonary embolisms developing, or post-operative bleeding, or complications, or readmissions, or 90-day mortality.

A difference was found between the two groups, pointing to a downside of using Coumadin routinely. The Coumadin group developed a significantly higher rate of wound-related complications.

This study demonstrates that a VTE prevention program for total knee replacement using aspirin instead of routine Coumadin as the medication part of the program can safely prevent VTE in a majority of patients who have a low VTE risk. With aspirin as part of the program, VTE can still be effectively prevented while the potential side effects and complications of taking Coumadin can be avoided for these patients.


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