Effect of Aspirin vs Enoxaparin on 90-Day Mortality in Patients Undergoing Hip or Knee Arthroplasty-Reference-Cited by-同舟云学术

Effect of Aspirin vs Enoxaparin on 90-Day Mortality in Patients Undergoing Hip or Knee Arthroplasty

Published:2023-06-09 Issue:6 Volume:6 Page:e2317838
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

,Sidhu Verinder S.¹²,Kelly Thu-Lan³,Pratt Nicole³,Graves Stephen E.⁴,Buchbinder Rachelle⁵,Adie Sam⁶,Cashman Kara⁷,Ackerman Ilana N.⁵,Bastiras Durga⁴,Brighton Roger⁸⁹,Burns Alexander W. R.¹⁰,Chong Beng Hock¹¹¹²,Clavisi Ornella¹³,Cripps Maggie¹³,Dekkers Mark¹⁴,de Steiger Richard¹⁵,Dixon Michael¹⁶,Ellis Andrew¹⁷¹⁸,Griffith Elizabeth C.⁷,Hale David¹⁹,Hansen Amber¹²,Harris Anthony²⁰,Hau Raphael¹⁵²¹,Horsley Mark²²,James Dugal²³,Khorshid Omar²⁴,Kuo Leonard²⁵,Lewis Peter L.²⁶²⁷,Lieu David²⁸,Lorimer Michelle⁷,MacDessi Samuel J.⁶²⁹,McCombe Peter³⁰,McDougall Catherine³¹,Mulford Jonathan³²,Naylor Justine Maree¹²,Page Richard S.³³,Radovanovic John³⁴,Solomon Michael³⁵,Sorial Rami³⁶,Summersell Peter³⁷,Tran Phong³⁸,Walter William L.¹⁷¹⁸³⁹,Webb Steve⁴⁰⁴¹,Wilson Chris⁴²⁴³,Wysocki David⁴⁴,Harris Ian A.¹²⁴⁵

Affiliation:

1. School of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia

2. Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia

3. Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia

4. Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia

5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

6. School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia

7. South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia

8. Orthopaedic Department, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia

9. Orthopaedic Department, Lakeview Private Hospital, Baulkham Hills, Sydney, New South Wales, Australia

10. Orthopaedic Department, Calvary John James Hospital, Deakin, Australian Capital Territory, New South Wales, Australia

11. Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia

12. Department of Hematology, New South Wales Pathology, Kogarah Campus, Sydney, New South Wales, Australia

13. Musculoskeletal Australia, Melbourne, Victoria, Australia

14. Orthopaedic Department, Greenslopes Private Hospital, Greenslopes, Queensland, Australia

15. Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia

16. Orthopaedic Department, Kareena Private Hospital, Sutherland, New South Wales, Australia

17. Orthopaedic Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia

18. Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia

19. Orthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, New South Wales, Australia

20. Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia

21. Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia

22. Orthopaedic Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia

23. Bendigo Healthcare Group, Bendigo Hospital, Bendigo, Victoria, Australia

24. Orthopaedic Department, Fremantle Hospital, Fremantle, Perth, Western Australia, Australia

25. Orthopaedic Department, Canterbury Hospital, Canterbury, New South Wales, Australia

26. Calvary Adelaide Hospital, Adelaide, South Australia, Australia

27. Discipline of Medical Specialties, University of Adelaide, Adelaide, South Australia, Australia

28. Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia

29. Orthopaedic Department, St George Private Hospital, Kogarah, New South Wales, Australia

30. Orthopaedic Department, Frankston Hospital, Frankston, Victoria, Australia

31. Orthopaedic Department, The Prince Charles Hospital, Chermside, Queensland, Australia

32. Orthopaedic Department, Launceston General Hospital, Launceston, Tasmania, Australia

33. School of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Australia

34. Orthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, Queensland, Australia

35. Orthopaedic Department, Prince of Wales Hospital, Randwick, New South Wales, Australia

36. Orthopaedic Department, Nepean Hospital, Penrith, New South Wales, Australia

37. Orthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia

38. Orthopaedic Department, Western Health, Melbourne, Victoria, Australia

39. The Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia

40. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

41. St John of God Health Care, Perth, Western Australia, Australia

42. Orthopaedic Department, Flinders Medical Centre, Bedford Park, South Australia, Australia

43. Department of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia

44. Orthopaedic Department, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia

45. Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

Abstract

ImportanceIschemic heart disease remains the leading cause of mortality following hip and knee arthroplasty. Due to its antiplatelet and cardioprotective properties, aspirin has been proposed as an agent that could reduce mortality when used as venous thromboembolism (VTE) prophylaxis following these procedures.ObjectiveTo compare aspirin with enoxaparin in reducing 90-day mortality for patients undergoing hip or knee arthroplasty procedures.Design, Setting, and ParticipantsThis study was a planned secondary analysis of the CRISTAL cluster randomized, crossover, registry-nested trial performed across 31 participating hospitals in Australia between April 20, 2019, and December 18, 2020. The aim of the CRISTAL trial was to determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE following hip or knee arthroplasty. The primary study restricted the analysis to patients undergoing total hip or knee arthroplasty for a diagnosis of osteoarthritis only. This study includes all adult patients (aged ≥18 years) undergoing any hip or knee arthroplasty procedure at participating sites during the course of the trial. Data were analyzed from June 1 to September 6, 2021.InterventionsHospitals were randomized to administer all patients oral aspirin (100 mg daily) or subcutaneous enoxaparin (40 mg daily) for 35 days after hip arthroplasty and 14 days after knee arthroplasty procedures.Main Outcomes and MeasuresThe primary outcome was mortality within 90 days. The between-group difference in mortality was estimated using cluster summary methods.ResultsA total of 23 458 patients from 31 hospitals were included, with 14 156 patients allocated to aspirin (median [IQR] age, 69 [62-77] years; 7984 [56.4%] female) and 9302 patients allocated to enoxaparin (median [IQR] age, 70 [62-77] years; 5277 [56.7%] female). The mortality rate within 90 days of surgery was 1.67% in the aspirin group and 1.53% in the enoxaparin group (estimated difference, 0.04%; 95% CI, −0.05%-0.42%). For the subgroup of 21 148 patients with a nonfracture diagnosis, the mortality rate was 0.49% in the aspirin group and 0.41% in the enoxaparin group (estimated difference, 0.05%; 95% CI, −0.67% to 0.76%).Conclusions and RelevanceIn this secondary analysis of a cluster randomized trial comparing aspirin with enoxaparin following hip or knee arthroplasty, there was no significant between-group difference in mortality within 90 days when either drug was used for VTE prophylaxis.Trial Registrationhttp://anzctr.org.auIdentifier:ACTRN12618001879257

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2805803/sidhu_2023_oi_230535_1685637272.31943.pdf

Reference31 articles.

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2. Effect of aspirin vs enoxaparin on symptomatic venous thromboembolism in patients undergoing hip or knee arthroplasty: the CRISTAL randomized trial.;Sidhu;JAMA,2022

3. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty.;Anderson;N Engl J Med,2018

4. Mortality after total hip replacement surgery: a systematic review.;Berstock;Bone Joint Res,2014

5. Mortality after total knee arthroplasty: a systematic review of incidence, temporal trends, and risk factors.;Berstock;J Bone Joint Surg Am,2018

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