Efficacy and safety of Aspirin plus intermittent pneumatic compression device as thromboprophylaxis after total hip arthroplasty : prospective randomized control trial

Abstract

Total hip arthroplasty is extremely successful orthopedics procedure that relieves pain, improve function, and enhance the quality of patient’s lives. However, this procedure is not without complications, the most notable being the risk of morbidity and mortality from the venous thromboembolic events. The purpose of this study was to find out the incidences of deep vein thrombosis and pulmonary embolism in Indian patients undergoing total hip joint arthroplasty and compare effectiveness and safety of thromboprophylaxis with aspirin plus intermittent pneumatic compression device with that of low molecular weight heparin.

Patients who had total hip arthroplasty (unilateral/bilateral) were randomized to receive prophylaxis with aspirin plus intermittent pneumatic compression device or low molecular weight heparin. After four to six days, all patients underwent bilateral lower-extremity color doppler ultrasonography to screen for deep venous thrombi in the calf, thigh, and pelvic veins. Any clinical symptoms of pulmonary embolism were evaluated clinically by cardiologist
and confirmed with pulmonary CT angiography. Bleeding events in both groups were documented. The patients were followed up at 6 week and 3 month with color doppler to look for the evidence of deep venous thrombi.

180 patients (224) joints) were randomized into 2 groups and studied regarding the incidence of deep vein thrombosis and pulmonary embolism and safety and efficacy of the drugs used as thromboprophylaxis.  Demographics were similar clinically between the groups. Prevalence of deep vein thrombosis and pulmonary embolism in Indian patients who underwent total hip arthroplasty was 1.11% and 0.55% respectively. The rates of deep venous thrombosis were 2.22%, in the aspirin plus compression group compared 0% in the low molecular weight heparin group. The rates of pulmonary embolism were 1.11% in the Aspirin plus compression group and 0% in the heparin group, and there were no fatal pulmonary emboli. Within the six weeks and three months follow-up, no thromboembolic events occurred. The rate of major bleeding events was 1.11% in the aspirin and compression group and 10% in the low-molecular-weight heparin group.

An inexpensive multimodal protocol, consisting of aspirin, exercises, and the use of intermittent compression devices, was associated with few thromboembolic complications.

When compared with low-molecular-weight heparin, use of the aspirin plus intermittent pneumatic compression device for prophylaxis against venous thromboembolic events following total hip arthro-plasty resulted in a significant decrease in major bleeding events.

Level of Evidence: Therapeutic Level I