What's the best anticoagulant to use after orthopedic surgeries? That depends on the type of procedure, say the authors of a study published in the Journal of Hospital Medicine.
Their review of 8 trials involving about 1,400 patients compared rates of venous thromboembolism (VTE) and bleeding with the use of aspirin, heparin and warfarin after major lower extremity surgeries.
According to the findings, aspirin was just as effective as heparin and warfarin in preventing blood clots and caused 68% fewer serious bleeding events following hip or knee replacements. However, the study notes, administering the conventional anticoagulants is best after hip fracture repair.
The study's authors note that national guidelines recommend the use of pharmacologic thromboprophylaxis to prevent VTE in these patients, but fail to identify which agents are best, leaving individual physicians to determine the optimal therapy. Lead author Frank Drescher, MD, of the Veterans Affairs Medical Center in White River Junction, Vt., hopes the findings will help guide physicians' decision-making about how to minimize surgical risks.
"We expect that the number of hip and knee replacements and hip fracture repairs will continue to grow as the population ages," he says. "Major complications after these procedures — often clots or bleeding — contribute to suffering and costs."