D'Amore Taylor, Cozzarelli Nicholas F, Sutton Ryan, Lonner Jess H, Fillingham Yale A
Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2024 Sep;39(9S2):S129-S133. doi: 10.1016/j.arth.2024.06.023. Epub 2024 Jun 16.
Low-dose aspirin is an effective venous thromboembolism (VTE) prophylactic medication in primary total joint arthroplasty, but the efficacy and safety of the formulations of chewable and enteric-coated aspirin have not been compared. The purpose of this study was to investigate the VTE and gastrointestinal (GI) complication rates of chewable and enteric-coated 81 mg aspirin bis in die for VTE prophylaxis in primary total joint arthroplasty.
A retrospective, single-institution cohort study was performed on patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2017 to 2021. Comparisons were made between 4,844 patients who received chewable, noncoated aspirin 81 mg and 4,388 patients who received enteric-coated 81 mg aspirin. Power analysis demonstrated 1,978 and 3,686 patients were needed per group to achieve a power of 80% for 90-day VTE rates (using inferiority testing) and GI complications (using superiority testing), respectively. Patients had similar baseline characteristics. Statistical analyses were done using t-tests and Chi-squared tests, with statistical significance defined as a P value < .05.
There were no significant differences in the incidences of postoperative VTE (0.31% versus 0.55%; P = .111) or GI complications (0.14% versus 0.14%; P = 1.000) between patients who received either chewable or enteric-coated 81 mg aspirin bis in die in the overall comparison that included both THA and TKA patients combined, or THA patients alone. However, the VTE incidence for TKA patients alone was significantly lower with chewable than enteric-coated aspirin (0.22% versus 0.62%; P = .037), with no difference in GI complications (0.13% versus 0.19%; P = .277).
Low-dose aspirin in enteric-coated formulation is inferior to chewable aspirin for VTE prophylaxis in primary TKA, but not inferior in THA patients. Both formulations have a similar GI complication rate. Therefore, it is reasonable to consider a transition from enteric-coated to uncoated chewable low-dose aspirin.
低剂量阿司匹林是初次全关节置换术中有效的静脉血栓栓塞症（VTE）预防药物，但咀嚼型和肠溶型阿司匹林制剂的疗效和安全性尚未得到比较。本研究的目的是调查咀嚼型和肠溶型81毫克双剂量阿司匹林在初次全关节置换术中预防VTE的VTE和胃肠道（GI）并发症发生率。
对2017年至2021年接受初次全髋关节置换术（THA）和全膝关节置换术（TKA）的患者进行了一项回顾性、单机构队列研究。对4844例接受咀嚼型、非肠溶81毫克阿司匹林的患者和4388例接受肠溶81毫克阿司匹林的患者进行了比较。功效分析表明，每组分别需要1978例和3686例患者才能在90天VTE发生率（采用非劣效性检验）和GI并发症（采用优效性检验）方面达到80%的功效。患者具有相似的基线特征。使用t检验和卡方检验进行统计分析，统计学显著性定义为P值<0.05。
在包括THA和TKA患者的总体比较中，接受咀嚼型或肠溶型81毫克双剂量阿司匹林的患者术后VTE发生率（0.31%对0.55%；P = 0.111）或GI并发症发生率（0.14%对0.14%；P = 1.00）无显著差异，单独的THA患者也是如此。然而，单独的TKA患者中，咀嚼型阿司匹林的VTE发生率显著低于肠溶型阿司匹林（0.22%对0.62%；P = 0.037），GI并发症无差异（0.13%对0.19%；P = 0.277）。
在初次TKA中，肠溶型低剂量阿司匹林在预防VTE方面不如咀嚼型阿司匹林，但在THA患者中并不逊色。两种制剂的GI并发症发生率相似。因此，考虑从肠溶型低剂量阿司匹林过渡到未包衣的咀嚼型低剂量阿司匹林是合理的。
