Comparison of low molecular weight heparin, aspirin, and their combination for the prevention of thrombosis after total knee arthroplasty in obese patients

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-03-18 DOI:10.1002/jeo2.70218

Alireza Mirahmadi, Pooya Hosseini-Monfared, Shahrzad Ghane, Mohammad Mortazavi, Ramin Abrishami, Mohammad Hossein Hooshangi, Vahid Shameli, Seyed Morteza Kazemi

{"title":"Comparison of low molecular weight heparin, aspirin, and their combination for the prevention of thrombosis after total knee arthroplasty in obese patients","authors":"Alireza Mirahmadi, Pooya Hosseini-Monfared, Shahrzad Ghane, Mohammad Mortazavi, Ramin Abrishami, Mohammad Hossein Hooshangi, Vahid Shameli, Seyed Morteza Kazemi","doi":"10.1002/jeo2.70218","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Patients undergoing total knee arthroplasty (TKA) are at a high risk of thromboembolic events, which is higher in obese patients. Determining the appropriate prophylaxis for venous thromboembolism (VTE) in obese patients is challenging. Therefore, we aimed to compare the effects of low molecular weight heparin (LMWH) with aspirin (ASA) and their combination for the prevention of thromboembolic events after TKA in obese patients.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In a retrospective study, 245 obese patients with BMIs over 30 who underwent TKA were enroled. Eligible patients were divided into three groups: Group A was given LMWH sodium (Clexane®) for 14 days, Group B was given ASA for 14 days, and Group C was given LMWH sodium (Clexane®) for 5 days and then ASA twice daily for the days between 5 and 14 postoperatively. The primary outcome was the incidence of VTE within three months. Secondary outcomes included routine laboratory evaluations (PT, PTT, INR, Hb, Hct, platelets, BUN and Cr) and adverse effects of ASA and LMWH, such as bleeding, anaemia, thrombocytopenia, and gastrointestinal or neurological symptoms.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Regarding the incidence of DVT and PTE, we did not observe significant differences between groups (<i>p</i> > 0.05). A total of seven symptomatic VTE was observed in six patients. We observed two cases with PE who were in the Clexane group. Moreover, five individuals had DVT in the follow-up: three cases in the Clexane group, one in the ASA group, and one in the ASA + Clexane group, which was not statistically significant (<i>p</i> > 0.05). There were no differences between groups regarding the risk of adverse events and complications.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>We found that ASA is not inferior to enoxaparin in reducing VTE after TKA in obese patients. Therefore, given ASA's low cost and greater convenience, it may be considered a reasonable alternative for extended VTE prophylaxis for TKA surgery in obese patients.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"12 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jeo2.70218","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70218","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Patients undergoing total knee arthroplasty (TKA) are at a high risk of thromboembolic events, which is higher in obese patients. Determining the appropriate prophylaxis for venous thromboembolism (VTE) in obese patients is challenging. Therefore, we aimed to compare the effects of low molecular weight heparin (LMWH) with aspirin (ASA) and their combination for the prevention of thromboembolic events after TKA in obese patients.

Methods

In a retrospective study, 245 obese patients with BMIs over 30 who underwent TKA were enroled. Eligible patients were divided into three groups: Group A was given LMWH sodium (Clexane®) for 14 days, Group B was given ASA for 14 days, and Group C was given LMWH sodium (Clexane®) for 5 days and then ASA twice daily for the days between 5 and 14 postoperatively. The primary outcome was the incidence of VTE within three months. Secondary outcomes included routine laboratory evaluations (PT, PTT, INR, Hb, Hct, platelets, BUN and Cr) and adverse effects of ASA and LMWH, such as bleeding, anaemia, thrombocytopenia, and gastrointestinal or neurological symptoms.

Results

Regarding the incidence of DVT and PTE, we did not observe significant differences between groups (p > 0.05). A total of seven symptomatic VTE was observed in six patients. We observed two cases with PE who were in the Clexane group. Moreover, five individuals had DVT in the follow-up: three cases in the Clexane group, one in the ASA group, and one in the ASA + Clexane group, which was not statistically significant (p > 0.05). There were no differences between groups regarding the risk of adverse events and complications.

Conclusion

We found that ASA is not inferior to enoxaparin in reducing VTE after TKA in obese patients. Therefore, given ASA's low cost and greater convenience, it may be considered a reasonable alternative for extended VTE prophylaxis for TKA surgery in obese patients.

Level of Evidence

Level III.

Abstract Image

查看原文本刊更多论文

低分子肝素与阿司匹林及其联用预防肥胖患者全膝关节置换术后血栓形成的比较

目的：接受全膝关节置换术（TKA）的患者发生血栓栓塞事件的风险较高，肥胖患者的风险更高。确定适当预防静脉血栓栓塞（VTE）在肥胖患者是具有挑战性的。因此，我们旨在比较低分子肝素（LMWH）与阿司匹林（ASA）及其联合使用对肥胖患者TKA后血栓栓塞事件的预防作用。方法回顾性研究245例bmi超过30的TKA患者。符合条件的患者分为三组：A组患者给予低分子肝素钠（Clexane®）治疗14天，B组患者给予ASA治疗14天，C组患者给予低分子肝素钠（Clexane®）治疗5天，然后ASA每日2次，持续5 ~ 14天。主要观察指标是三个月内静脉血栓栓塞的发生率。次要结局包括常规实验室评估（PT、PTT、INR、Hb、Hct、血小板、BUN和Cr）以及ASA和低分子肝素的不良反应，如出血、贫血、血小板减少、胃肠道或神经系统症状。结果组间DVT、PTE发生率差异无统计学意义（p > 0.05）。6例患者共出现7例症状性静脉血栓栓塞。我们观察了2例PE患者，他们在Clexane组。随访中出现DVT 5例，Clexane组3例，ASA组1例，ASA + Clexane组1例，差异无统计学意义（p > 0.05）。在不良事件和并发症的风险方面，两组之间没有差异。结论我们发现ASA在降低肥胖患者TKA后VTE方面并不亚于依诺肝素。因此，鉴于ASA的低成本和更大的便利性，它可能被认为是肥胖患者TKA手术中延长静脉血栓栓塞预防的合理选择。证据等级三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊