Aspirin Thromboprophylaxis is Non-inferior to LMWH for Prevention of Death and Pulmonary Embolism after Orthopedic Trauma

Clinical question: Is aspirin as effective as low-molecular-weight heparin (LMWH) for thromboprophylaxis in patients with orthopedic trauma? Background: Studies have outlined the benefits of thromboprophylaxis in patients with traumatic orthopedic injuries to prevent thromboembolic complications and death. Recent studies suggest aspirin may be an effective alternative to LMWH in patients who have undergone total joint arthroplasty. However, similar data in patients with orthopedic trauma is limited. Study design: Pragmatic, multicenter, randomized, noninferiority trial Setting: 21 adult trauma centers across the U.S. and Canada Synopsis: 12,211 adult patients with an extremity fracture requiring operative management (excluding fractures of the hand or forefoot) or any pelvic or acetabular fracture regardless of management strategy were randomly assigned to receive aspirin thromboprophylaxis (81 mg twice daily orally) versus LMWH (30 mg twice daily subcutaneously, with flexibility in dosing based on weight, renal function, or other individual patient factors) while admitted. The duration of post-discharge therapy was left to the treating physician’s discretion. Results indicated noninferiority of aspirin versus LMWH in the prevention of all-cause mortality (0.78% versus 0.73%; 96.2% CI, -0.27 to 0.38; P <0.0001). The authors also found no difference in the secondary outcomes of pulmonary embolism, bleeding complications, wound complications, or surgical site infections. T...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: In the Literature Pulmonology Source Type: research