Aspirin is Not for Everyone: Discharge to Non-home Facilities After Total Hip and Knee Arthroplasty Increases Risk of Venous Thromboembolism

Michael McHugh, MD; Stefano Muscatelli, MD; Mathieu Squires, MD; Nicole Honey, MD; Conor Locke, MS; Elizabeth Dailey, MD

Arthroplasty Today (Jun 2024)

Aspirin is Not for Everyone: Discharge to Non-home Facilities After Total Hip and Knee Arthroplasty Increases Risk of Venous Thromboembolism

Michael McHugh, MD,
Stefano Muscatelli, MD,
Mathieu Squires, MD,
Nicole Honey, MD,
Conor Locke, MS,
Elizabeth Dailey, MD

Affiliations

Michael McHugh, MD: Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA
Stefano Muscatelli, MD: Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA
Mathieu Squires, MD: Corresponding author. Department of Orthopaedic Surgery, University of Michigan, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI 48109, USA. Tel.: +1 702 496 2664.; Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA
Nicole Honey, MD: Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA
Conor Locke, MS: Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA
Elizabeth Dailey, MD: Department of Orthopaedic Surgery, University of Michigan, Orthopaedic Surgery Department, Ann Arbor, MI, USA

Journal volume & issue: Vol. 27
p. 101368

Abstract

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Background: Patients discharged to non-home facilities (NHD) after total hip arthroplasty (THA) and total knee (TKA) arthroplasty experience higher rates of adverse events and may require more aggressive venous thromboembolism (VTE) chemoprophylaxis. Our aim was to compare the rates of VTE in NHD patients and those discharged home (HD) after THA/TKA. Our secondary aim was to determine VTE rates within HD and NHD groups when stratified by chemoprophylactic regimen. Methods: A retrospective cohort of primary THA and TKA patients were stratified into HD and NHD, then allocated into groups by chemoprophylactic regimen on discharge: aspirin alone (AA), more aggressive (MA) chemoprophylaxis, and other regimens (other). The primary outcome was VTE. Rates of VTE in HD and NHD patients, as well as AA and MA regimens, were analyzed using a generalized linear regression model. Results: Six thousand three hundred seventy-nine patients were included with 1.03% experiencing VTE. HD had lower rates of VTE compared to NHD (0.83% vs 2.17%, P < .001). AA had similar rates of VTE compared to MA (0.99% vs 1.08%, P = .82). NHD patients had a lower VTE rate with MA vs AA prophylaxis (1.47% vs 3.83%, P = .016). HD patients treated with AA vs MA had no difference in VTE rates (0.76% vs 0.96%, P = .761). Conclusions: NHD patients have higher rates of VTE than HD patients. However, NHD patients have significantly lower rates of VTE on MA chemoprophylaxis compared to those on AA. Providers should consider prescribing MA VTE chemoprophylaxis for NHD patients. Prospective, randomized studies are necessary to confirm these recommendations.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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