TY - JOUR
T1 - Aspirin versus low-molecular-weight heparin for extended venous thromboembolism prophylaxis after total hip arthroplasty
T2 - A randomized trial
AU - Anderson, David R.
AU - Dunbar, Michael J.
AU - Bohm, Eric R.
AU - Belzile, Etienne
AU - Kahn, Susan R.
AU - Zukor, David
AU - Fisher, William
AU - Gofton, Wade
AU - Gross, Peter
AU - Pelet, Stephane
AU - Crowther, Mark
AU - Macdonald, Steven
AU - Kim, Paul
AU - Pleasance, Susan
AU - Davis, Nicki
AU - Andreou, Pantelis
AU - Wells, Philip
AU - Kovacs, Michael
AU - Rodger, Marc A.
AU - Ramsay, Tim
AU - Carrier, Marc
AU - Vendittoli, Pascal Andre
PY - 2013/6/4
Y1 - 2013/6/4
N2 - Background: The role of aspirin in thromboprophylaxis after total hip arthroplasty (THA) is controversial. Objective: To compare extended prophylaxis with aspirin and dalteparin for prevention of symptomatic venous thromboembolism (VTE) after THA. Design: Multicenter randomized, controlled trial with a noninferiority design based on a minimal clinically important difference of 2.0%. Randomization was electronically generated; patients were assigned to a treatment group through a Web-based program. Patients, physicians, study coordinators, health care team members, outcome adjudicators, and data analysts were blinded to interventions. (Current Controlled Trials: ISRCTN11902170) Setting: 12 tertiary care orthopedic referral centers in Canada. Patients: 778 patients who had elective unilateral THA between 2007 and 2010. Intervention: After an initial 10 days of dalteparin prophylaxis after elective THA, patients were randomly assigned to 28 days of dalteparin (n = 400) or aspirin (n = 386). Measurements: Symptomatic VTE confirmed by objective testing (primary efficacy outcome) and bleeding. Results: Five of 398 patients (1.3%) randomly assigned to dalteparin and 1 of 380 (0.3%) randomly assigned to aspirin had VTE (absolute difference, 1.0 percentage point [95% CI, -0.5 to 2.5 percentage points]). Aspirin was noninferior (P < 0.001) but not superior (P = 0.22) to dalteparin. Clinically significant bleeding occurred in 5 patients (1.3%) receiving dalteparin and 2 (0.5%) receiving aspirin. The absolute between-group difference in a composite of all VTE and clinically significant bleeding events was 1.7 percentage points (CI, -0.3 to 3.8 percentage points; P = 0.091) in favor of aspirin. Limitation: The study was halted prematurely because of difficulty with patient recruitment. Conclusion: Extended prophylaxis for 28 days with aspirin was noninferior to and as safe as dalteparin for the prevention of VTE after THA in patients who initially received dalteparin for 10 days. Given its low cost and greater convenience, aspirin may be considered a reasonable alternative for extended thromboprophylaxis after THA. Primary Funding Source: Canadian Institutes of Health Research.
AB - Background: The role of aspirin in thromboprophylaxis after total hip arthroplasty (THA) is controversial. Objective: To compare extended prophylaxis with aspirin and dalteparin for prevention of symptomatic venous thromboembolism (VTE) after THA. Design: Multicenter randomized, controlled trial with a noninferiority design based on a minimal clinically important difference of 2.0%. Randomization was electronically generated; patients were assigned to a treatment group through a Web-based program. Patients, physicians, study coordinators, health care team members, outcome adjudicators, and data analysts were blinded to interventions. (Current Controlled Trials: ISRCTN11902170) Setting: 12 tertiary care orthopedic referral centers in Canada. Patients: 778 patients who had elective unilateral THA between 2007 and 2010. Intervention: After an initial 10 days of dalteparin prophylaxis after elective THA, patients were randomly assigned to 28 days of dalteparin (n = 400) or aspirin (n = 386). Measurements: Symptomatic VTE confirmed by objective testing (primary efficacy outcome) and bleeding. Results: Five of 398 patients (1.3%) randomly assigned to dalteparin and 1 of 380 (0.3%) randomly assigned to aspirin had VTE (absolute difference, 1.0 percentage point [95% CI, -0.5 to 2.5 percentage points]). Aspirin was noninferior (P < 0.001) but not superior (P = 0.22) to dalteparin. Clinically significant bleeding occurred in 5 patients (1.3%) receiving dalteparin and 2 (0.5%) receiving aspirin. The absolute between-group difference in a composite of all VTE and clinically significant bleeding events was 1.7 percentage points (CI, -0.3 to 3.8 percentage points; P = 0.091) in favor of aspirin. Limitation: The study was halted prematurely because of difficulty with patient recruitment. Conclusion: Extended prophylaxis for 28 days with aspirin was noninferior to and as safe as dalteparin for the prevention of VTE after THA in patients who initially received dalteparin for 10 days. Given its low cost and greater convenience, aspirin may be considered a reasonable alternative for extended thromboprophylaxis after THA. Primary Funding Source: Canadian Institutes of Health Research.
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U2 - 10.7326/0003-4819-158-11-201306040-00004
DO - 10.7326/0003-4819-158-11-201306040-00004
M3 - Article
C2 - 23732713
AN - SCOPUS:84878738746
SN - 0003-4819
VL - 158
SP - 800
EP - 806
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 11
ER -