Aspirin Versus Potent Venous Thromboembolism Chemoprophylaxis in Total Knee Arthroplasty: Reduced Postoperative Pain and Complications With Aspirin Use.
Academic Article
Overview
abstract
BACKGROUND: The optimal postoperative venous thromboembolism chemoprophylaxis (VTEC) to balance venous thromboembolism (VTE) reduction with pain management, wound complications, and functional outcomes remains controversial. This study compared postoperative pain and early outcomes in patients undergoing total knee arthroplasty (TKA) who received aspirin versus potent anticoagulation (AC) regimens. METHODS: We identified 14,216 primary TKAs for osteoarthritis performed between 2016 and 2023 at a single institution. Postoperative VTEC regimens included aspirin in 9,076 patients, potent AC (i.e., apixaban, rivaroxaban, warfarin, heparin, and enoxaparin) in 4,506, and chronic potent AC in 661. Outcomes included in-hospital opioid consumption (morphine milligram equivalents [MMEs]), lengths of stay (LOS), 90-day outpatient opioids, 180-day manipulations under anesthesia (MUA), and 90-day complications. Outcomes were assessed with multivariable regression models controlling for relevant clinical variables. RESULTS: Compared to the aspirin group, 90-day outpatient and total opioid use was higher in the AC group (adjusted mean difference: +285.0 MMEs; P < 0.001 and +295.6 MMEs; P < 0.001, respectively) and chronic AC group (+127.7 MMEs; P = 0.002 and +127.3 MMEs; P = 0.002). In-hospital opioid use was higher in the AC group (+10.5 MMEs; P < 0.001). Lengths of stay were longer for AC (+12.1 hours; P < 0.001) and chronic AC groups (+5.6 hours; P < 0.001). The AC group had higher odds of MUA within 180 days (odds ratio: 1.45; P = 0.0003) and 90-day readmission (1.31; P = 0.004). No differences were observed for VTE, myocardial infarction, reoperation, or wound drainage (P > 0.36). CONCLUSIONS: The TKA patients treated with potent AC for VTE prophylaxis versus aspirin experienced more postoperative pain in the first 90 days, higher opioid requirements, increased LOS, and increased risk of MUA. Aspirin should be favored for VTEC to reduce the risk of postoperative pain in TKA patients when medically appropriate.
