Aspirin and compression devices versus low-molecular-weight heparin and PCD for VTE prophylaxis in orthopedic oncology patients.

BACKGROUND

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are possible sources of morbidity and mortality in patients with musculoskeletal neoplasms (MSN).

OBJECTIVE

To compare the efficacy of aspirin (ASA) and pneumatic compression devices (PCD) to low-molecular-weight heparin (LMWH) and PCD in patients undergoing orthopedic procedures for MSN of the pelvis or lower extremity.

METHODS

Of 348 patients who met the study criteria, 195 were treated with ASA/PCD and 153 with LMWH/PCD. There were 18 DVT including 8 in ASA/PCD group and 10 in LMWH/PCD group. There were four PEs, all in the LMWH/PCD group.

RESULTS

We found no significant difference in DVT rate between ASA/PCD and LMWH/PCD when used for prophylaxis against thromboembolic complications. Our analysis shows that procedures of the thigh, soft tissue resections, and malignant disease were more often managed with ASA/PCD while joint arthroplasty, procedures of the hip/pelvis, and metastatic disease were more often managed with LMWH/PCD.

CONCLUSION

DVT prophylaxis in orthopedic oncology remains a complex topic in which physicians must balance the risks of thromboembolic disease against the risks of post-operative complications.