"A prospective study on the effectiveness of monoprophylaxis with aspirin to prevent thromboembolism in total knee arthroplasty patients".

Abstract

Venous thromboembolism (VTE) is a significant and serious complication occurring after lower limb arthroplasty surgeries, increasing morbidity and mortality. It is estimated that almost half of lower limb arthroplasty patients might develop deep vein thrombosis (DVT) without adequate prophylaxis. Pulmonary embolism (PE) is a possible consequence of DVT and leads to increased perioperative mortality rates after total joint replacements. It is therefore imperative to develop a standard guideline for thromboprophylaxis for lower limb arthroplasty patients. Non availability of sensitive and specific diagnostic methods in the post-operative period further adds to the problem. Non-invasive diagnostic modalities such as compression ultrasonography (USG), real-time B mode compression and colour Doppler USG are generally preferred over invasive modality such as venography which is considered to be the gold standard. Thromboprophylaxis can be achieved by pharmacological as well as nonpharmacological means. However, no consensus exists on the ideal thromboprophylaxis method. In this study, we have used aspirin as a single chemoprophylactic agent in patients of total knee replacement for the prophylaxis of symptomatic deep vein thrombosis for all patients with addition of mechanical prophylaxis as per risk stratified approach recommended by the AAOS. A total of 50 patients meeting the predefined selection criteria were enrolled for the study. Effectiveness of the same was measured by clinical & radiological assessment. We found that aspirin as a chemical monoprophylaxis along with mechanical methods lead to total risk mitigation for VTE in 98 % of our study population. There was one case of distal DVT (2 %) which was successfully managed by pharmacotherapy. Use of aspirin as a monoprophylaxis against DVT and PE is effective in patients undergoing total knee arthroplasty. Addition of a mechanical prophylaxis might be considered in higher risk patients.