Aspirin As A Prophylaxis For Fatal Pulmonary Embolism

A study published provides results which challenge the current NICE guidelines (set in April 2007) relating to the use of low-molecular weight heparin (LMWH) rather than aspirin as a thromboprophylaxis following orthopaedic surgery.


Currently the guidance states that LMWH is preferable to aspirin and partly is based on two assumptions that the report's authors wished to test: that chemical and/or mechanical prophylaxis will reduce these complications and that orthopaedic operations, in particular elective hip and knee replacements, are high-risk.


The study analysed over 4,000 patients undergoing primary joint replacement, the majority of whom received aspirin only as a chemical prophylaxis. The overall death rate was 0.31% and the rate of fatal pulmonary embolism was 0.07%, while the overall mortality rate in the general population for gender and age matched controls was 50% more than those undergoing surgery.


Therefore, the report's authors conclude that 'it does seem unlikely that the adoption of LMWH could produce any further significant reduction on observed mortality in this patient group'. In addition, 'the fatal pulmonary embolism rate (0.07%) suggests that this is a rare event even after elective total joint replacement if aspirin is given', meaning that aspirin is an effective thromprophylaxis for patients after orthopaedic surgery.


Read the full text article.


Source

The Journal of Bone and Joint Surgery