IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN

G Matharu; C Garriga; M Whitehouse; A Rangan; A Judge

doi:10.1302/1358-992X.2020.5.018

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IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN

The British Hip Society (BHS) Annual Scientific Meeting, Newport, Wales, March 2020.

G Matharu
C Garriga
M Whitehouse
A Rangan
A Judge

IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN

Matharu G, Garriga C, Whitehouse M, Rangan A, Judge A. IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN. Orthop Procs. 2020;102-B(SUPP_5):18-18. doi:10.1302/1358-992X.2020.5.018

Matharu, G, et al. “IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN.” Orthopaedic Proceedings, vol. 102-B, no. SUPP_5, 2020, pp. 18-18., https://doi.org/10.1302/1358-992X.2020.5.018

Matharu, G., Garriga, C., Whitehouse, M., Rangan, A., & Judge, A. (2020). IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN. Orthopaedic Proceedings, 102-B(SUPP_5), 18-18. https://doi.org/10.1302/1358-992X.2020.5.018

Matharu, G., Garriga, C., Whitehouse, M., Rangan, A. and Judge, A. (2020) “IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN.” Orthopaedic Proceedings, 102-B(SUPP_5), pp. 18-18. Available at: https://doi.org/10.1302/1358-992X.2020.5.018

Matharu, G, C Garriga, M Whitehouse, A Rangan, and A Judge. “IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN.” Orthopaedic Proceedings 102-B, no. SUPP_5 (2020): 18-18. https://doi.org/10.1302/1358-992X.2020.5.018

Matharu G, Garriga C, Whitehouse M, Rangan A, Judge A. IS ASPIRIN AS EFFECTIVE AS THE NEWER DIRECT ORAL ANTICOAGULANTS FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS FOLLOWING TOTAL HIP ARTHROPLASTY? AN ANALYSIS FROM THE NATIONAL JOINT REGISTRY FOR ENGLAND, WALES, NORTHERN IRELAND, AND THE ISLE OF MAN. Orthop Procs. 2020 Jul 1;102-B(SUPP_5):18-18. https://doi.org/10.1302/1358-992X.2020.5.018

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Abstract

Background

Few studies have compared aspirin with DOACs (direct oral anticoagulants = direct thrombin inhibitors and factor Xa inhibitors) for venous thromboembolism (VTE) prophylaxis following total hip and knee replacement (THR and TKR). We assessed the efficacy and safety of aspirin compared with DOACs for VTE prophylaxis following THR and TKR using the world's largest joint replacement registry.

Methods

We studied the National Joint Registry linked to English hospital inpatient episodes for 218,650 THR and TKR patients. Patients receiving aspirin were matched separately to (1) direct thrombin inhibitors, and (2) factor Xa inhibitors using propensity scores. Outcomes assessed at 90 days included VTE, length of stay, and adverse events.

Results

Following THR, the risk of VTE was significantly lower in patients receiving direct thrombin inhibitors (0.44%; odds ratio (OR)=0.69, 95% confidence interval (CI)=0.55–0.87, p=0.002) and factor Xa inhibitors (0.37%; OR=0.63, CI=0.47–0.85, p=0.003) compared with aspirin (0.63%). Following THR, direct thrombin inhibitors (coefficient=−0.37, CI=−0.43 to −0.31, p<0.001) and factor Xa inhibitors (coefficient=−0.80, CI=−0.87 to −0.74, p<0.001) reduced length of stay compared with aspirin. Similar findings for both outcomes were observed following TKR. Compared with aspirin, DOACs did not increase the risk of short-term revision surgery; reoperation; major haemorrhage; wound disruption; surgical site infection; and mortality.

Conclusions

Following THR and TKR, the risk of VTE was lower in patients receiving DOACs compared with aspirin. DOACs were associated with a reduced length of stay, and DOACs did not increase the risk of further surgery, wound problems, bleeding complications, or mortality compared with aspirin.

Email: gsm@doctors.org.uk