Breaking News
January 23, 2019 - Bedfont to exhibit NObreath FeNO monitor at Arab Health 2019
January 23, 2019 - Nicotinamide riboside supplementation confers significant physiological benefits to mothers and offspring
January 23, 2019 - Increasing temperatures may help preserve crop nutrition
January 23, 2019 - Many Oncologists in the Dark About LGBTQ Health Needs
January 23, 2019 - Epigenetic change causes fruit fly babies to inherit diet-induced heart disease
January 23, 2019 - Erasing memories could reduce relapse rates among drug addicts
January 23, 2019 - African Americans who smoke cigarettes are more likely to develop peripheral artery disease
January 23, 2019 - Unique data combination helps FinnGen researchers to fund links between genetic factors and health
January 23, 2019 - Parents’ mental health problems associated with reactive attachment disorder in children
January 23, 2019 - Graphene Flagship project studies impact of graphene and related materials on our health
January 23, 2019 - The connection between the Pope and contraceptive pills
January 23, 2019 - Prior dengue infection could protect children from symptomatic Zika
January 23, 2019 - VISTA checkpoint implicated in pancreatic cancer immunotherapy resistance
January 23, 2019 - The Tiny Camera That Could Revolutionize Cardiovascular Surgery
January 23, 2019 - Peptide isolated from soil fungi has antitumor and antibacterial properties
January 23, 2019 - TGen identifies polio-like virus as potential cause of Acute Flaccid Myelitis outbreak
January 23, 2019 - Migrants and refugees do not bring disease and are at greater health risk themselves says WHO
January 23, 2019 - Examing the effects of menopause in workplace
January 23, 2019 - Enemy number 1 – Air pollution and climate change top of WHO agenda
January 23, 2019 - Two Positive Phase III studies of Tafenoquine for the Radical Cure of Plasmodium vivax Malaria Published in The New England Journal of Medicine
January 23, 2019 - World Trade Center responders at increased risk for head and neck cancers
January 23, 2019 - Low-sugar diet leads to significant improvement in nonalcoholic fatty liver disease in boys
January 23, 2019 - Chaos in bodily regulation can optimize our immune system, finds study
January 23, 2019 - Short, text-based exercises can increase happiness for adults recovering from substance use disorders
January 23, 2019 - Body size may have greater influence on women’s lifespan than men
January 23, 2019 - Groundbreaking tool helps visualize neuronal activity with near-infrared light
January 23, 2019 - Prior dengue immunity in children may be protective against symptomatic Zika
January 23, 2019 - Holocaust survivors with PTSD and their offspring exhibit more unhealthy behavior patterns
January 23, 2019 - Scientists discover new genetic mutations causing inherited deaf-blindness
January 23, 2019 - UC team designs new naloxone-dispensing smart device
January 23, 2019 - Torrent Pharmaceuticals Limited Issues Voluntary Nationwide Recall of Losartan Potassium Tablets, USP and Losartan Potassium and Hydrochlorothiazide Tablets, USP
January 23, 2019 - Brain activity shows development of visual sensitivity in autism
January 23, 2019 - Two hour gap between dinner and sleep is overrated says Japanese research
January 23, 2019 - Fear and embarrassment are causing smear test numbers to plummet
January 23, 2019 - Protein-secreting device implanted in epileptic rats reduces seizures, improves cognition
January 23, 2019 - Reintroduction project recovers current wild population of green turtle in Cayman Islands
January 23, 2019 - Cancer survivors face greater financial burden related to medical bills
January 23, 2019 - PSA screening reduces prostate cancer deaths by 30%
January 23, 2019 - LSTM receives grant to help improve health of people living in informal settlements
January 23, 2019 - Hemochromatosis Mutation Linked to Other Morbidity
January 23, 2019 - Why early diagnosis of autism should lead to early intervention
January 23, 2019 - Aspirin May Lower Stroke Risk in Women with History of Preeclampsia
January 23, 2019 - Exposure to certain chemicals may be linked to decrease in blood pressure during pregnancy
January 23, 2019 - Bowel cancer on the rise among younger Australians
January 23, 2019 - Scientists have reversed memory loss in a mouse model of Alzheimer’s
January 23, 2019 - Defective molecular master switch could lead to age-related macular degeneration
January 23, 2019 - Researchers identify how concussions may contribute to seizures
January 23, 2019 - Short interval between last meal of the day and bedtime may not affect blood glucose levels
January 23, 2019 - Still Too Many Highway Deaths Tied to Speeding
January 23, 2019 - Prenatal valproate exposure linked to increased ADHD risk
January 23, 2019 - Compound identified that may help treat heart failure
January 23, 2019 - Undiagnosed Asthma in Urban Adolescents May Be Common
January 23, 2019 - Study describes metabolism of intestinal microbiota in babies for the first time
January 22, 2019 - Study links concussions to development of epilepsy
January 22, 2019 - Specialist-led hospital bereavement service may help restrain legal action after difficult deaths
January 22, 2019 - Genetic study reveals possible new routes to treating osteoarthritis
January 22, 2019 - Blood test may detect early signs of lung-transplant rejection
January 22, 2019 - Blood marker could aid in early prediction of Alzheimer’s progression
January 22, 2019 - Orthodontic treatment does not guarantee future dental health
January 22, 2019 - Rutgers researchers discover cause of bone loss in people with joint replacements
January 22, 2019 - Diversity among rural Africans extends to their gut microbiomes
January 22, 2019 - Newly developed biological system lets cells to create self-curving cornea
January 22, 2019 - VTv Therapeutics Announces Publication of Comprehensive Data in Science Translational Medicine Detailing the Discovery and Clinical Development of TTP399, including Results of Phase 2 AGATA Study
January 22, 2019 - about one in three adults with prediabetes has arthritis
January 22, 2019 - A look at how data is democratizing health care
January 22, 2019 - Alcohol-Linked Disease Overtakes Hep C As Top Reason For Liver Transplant
January 22, 2019 - Researchers identify new genes linked with age-related macular degeneration
January 22, 2019 - MPFI researchers identify synaptic logic for connections between two brain hemispheres
January 22, 2019 - New approach to reduce toxic protein production in ALS
January 22, 2019 - New study extends our knowledge of the link between miRNAs and cancer
January 22, 2019 - Asthma, eczema are not barriers to active lifestyle in teenagers
January 22, 2019 - Genetic changes may predict likelihood of relapse in breast cancer patients
January 22, 2019 - Antiepileptic drug use by people with Alzheimer’s disease linked to accumulation of hospital days
January 22, 2019 - IUPUI researcher receives $2.85 million grant to find ways to improve bone strength
January 22, 2019 - Precision medicine can help keep astronauts healthy during deep space missions
January 22, 2019 - Detecting signs of neurodegeneration earlier and more accurately
January 22, 2019 - Mouse studies challenge ‘inhibition’ theory of autism
January 22, 2019 - SSB launches BIOSTAT RM TX single-use bioreactor for producing consistent quality cellular products
January 22, 2019 - Experimental drug can positively modify key characteristic behavior in FXS patients
January 22, 2019 - Low-Income Women Lack Menstrual Hygiene Supplies
Aspirin may be effective in preventing blood clots after knee replacement

Aspirin may be effective in preventing blood clots after knee replacement

image_pdfDownload PDFimage_print

When it comes to preventing blood clots after a knee replacement, good old aspirin may be just as effective as newer, more expensive drugs.

That swap could help reduce the cost of caring for the nearly 1 million Americans who have a knee fixed each year, Michigan Medicine researchers say.

After knee surgery, there’s a risk of blood clots in the legs or lungs. So it’s routine for patients to take clot-preventing drugs for some time afterward.

Some doctors choose powerful anti-clotting drugs like heparin (Lovenox) and rivaroxaban (Xarelto), but it hasn’t been clear whether these expensive prescription drugs work any better than cheap, readily available aspirin.

“Aspirin alone may provide similar protection compared to anticoagulation treatments,” says Brian R. Hallstrom, M.D., an orthopedic surgeon and associate chair for quality and safety at the University of Michigan Department of Orthopaedic Surgery.

Hallstrom is the lead author of a new study published in JAMA Surgery that found few patients developed a blood clot after surgery, and those patients on aspirin fared just as well as those on anticoagulants.

Aspirin use growing

During the two-year study period from 2013 to 2015, aspirin use rose from 10 percent to 50 percent among the patients cared for by orthopaedic surgeons in the Michigan Arthroplasty Registry Collaborative Quality Initiative, a statewide effort to give patients the best possible recovery and outcomes after hip and knee replacements.

Since then, the shift has become even more distinct: Aspirin prescribing has risen to 70 percent among Michigan surgeons, says Hallstrom, who is co-director of the initiative and a health services researcher at U-M’s Institute for Healthcare Policy and Innovation.

Based on the experience of 41,537 Michigan patients undergoing knee replacement, the study may further the debate about the routine use of aspirin for clot prevention.

A recent Canadian study looked at the issue, but the analysis had a caveat: Each of the more than 3,400 clinical trial patients received rivaroxaban the first five days after surgery. After that, they continued with the drug or switched to aspirin.

The new U-M study suggests patients may be adequately protected if they take aspirin alone from day one.

“This study is truly a real-world experience of what happened in Michigan when the majority of surgeons switched to aspirin,” Hallstrom says. “The incidence of blood clots, pulmonary embolus and death did not increase despite this dramatic change in practice.”

Shifting procedure and dialogue

Over the past decade, surgeons have turned away from powerful anticoagulants and toward aspirin used in addition to nondrug improvements such as compression devices for thwarting clots.

These days, most patients have a generally low risk of blood clots after knee replacement for a number of reasons. Those reasons include shorter surgical times, less invasive procedures and use of regional anesthesia that allows early mobilization after surgery, Hallstrom says. Some patients are even going home the same day.

“The most important way to prevent blood clots is getting moving,” says Hallstrom, noting that people are at risk for blood clots when they sit or lie in one position for too long, such as on an airplane or a hospital bed.

Still, pharmaceutical recommendations vary.

The critical care specialists who make up the American College of Chest Physicians favor heparin to reduce the risk of blood clots, while the American Academy of Orthopaedic Surgeons guidelines state that no one drug is better than another for preventing clots.

Advantages of aspirin

The U-M study involved patients undergoing knee replacement surgery at any of the 29 Michigan hospitals in the surgical quality group. One-third of the patients took aspirin alone; 54 percent took only an anticoagulant; and 13 percent took an aspirin/anticoagulant combination.

Over three months, just 1.16 percent of aspirin patients developed a serious blood clot. That was true for 1.42 percent of anticoagulant patients, according to the Michigan study. This was not statistically different.

So, neither drug appeared better than the other — but aspirin has some obvious advantages.

“Aspirin is easy to take and much less expensive,” Hallstrom says. “Patients can get it over the counter for pennies, while the other anticoagulants require monitoring, injections, frequent dose adjustments and are extremely expensive.”

The reported cost for a 30-day supply of rivaroxaban is approximately $379 to $450; heparin is estimated at $450 to $890. Although warfarin costs a few dollars for a 30-day supply, its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in, Hallstrom says.

In contrast, aspirin costs approximately $2 a month.

The study suggests most patients can have just aspirin without increasing the risk for venous thromboembolism, but doctors need to consider factors such as a patient’s history of clots, obesity and ability to mobilize after surgery when determining the best measure for clot prevention, Hallstrom adds.

Source:

https://labblog.uofmhealth.org/rounds/aspirin-after-knee-surgery-offers-effective-clot-prevention-study-finds

Tagged with:

About author

Related Articles