Is Aspirin Alone Sufficient for Anticoagulation Following Knee Surgery?

Aspirin may be an appropriate alternative to other, more powerful drugs for the prevention of blood clots following knee replacement, according to the results of a recent study published online in JAMA Surgery.

“There has been significant debate in the surgical and medical communities regarding the appropriateness of using aspirin alone for venous thromboembolism (VTE) prophylaxis following total knee arthroplasty (TKA),” according to the authors of the study.

In order to examine the acceptability of aspirin alone in this situation, they conducted a noninferiority study of a retrospective cohort of 41,537 TKA cases from the Michigan Arthroplasty Registry Collaborative Quality Initiative.  

Of the 41,537 patients, 668 had neither aspirin nor anticoagulants, 12,831 had only aspirin, 22,620 had only anticoagulants (including heparin, warfarin, and Xa inhibitors), and 5418 had both aspirin and anticoagulants.

Overall, VTE events occurred in 573 of the 41,537 patients, 32 of whom received no pharmacologic prophylaxis, 149 of whom were treated with aspirin alone, 321 of whom were treated with anticoagulation alone, and 71 of whom were given both aspirin and anticoagulation.

The researchers found that aspirin alone was noinferior to other chemoprophylaxis. Bleeding occurred in 457 of 41,537 patients, 10 of whom received no pharmacologic prophylaxis, 116 of whom were treated with aspirin alone, 258 of whom were treated with anticoagulation alone, and 73 of whom were given both aspirin and anticoagulation.

“In this study of patients undergoing TKA, aspirin was not inferior to other anticoagulants in the postoperative rate of VTE or death. Aspirin alone may provide similar protection from postoperative VTE compared with other anticoagulation treatments.”

—Michael Potts

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