M. Mazzei1, M. Uohara2, S. Pasch2, E. Dauer1, Z. Maher1, L. L. Mason1, A. Pathak1, T. Santora1, L. O. Sjoholm1, A. J. Goldberg1, J. M. Lopez1 1Temple University Hospital,Department Of Surgery,Philadelphia, PA, USA 2Temple University,Lewis Katz School Of Medicine,Philadelphia, PA, USA
Introduction: Low-molecular-weight heparin (LMWH) is an accepted standard of care for extended venous thromboembolism (VTE) prophylaxis after lower extremity trauma based on data extrapolated from elective orthopedic procedures, but can be limited due to cost and compliance. The aim of this study was to investigate the potential noninferiority of daily aspirin compared to LMWH in preventing symptomatic VTE after lower extremity trauma.
Methods: A six-year, single-institution, retrospective analysis of patients requiring surgical intervention for lower extremity trauma at a level one urban trauma center was performed. Subjects were included if they had no prior history of VTE, did not sustain lower extremity vascular injury, did not require therapeutic anticoagulation for any reason, and followed with trauma or orthopedic care providers for at least thirty days post-discharge. Subjects receiving LMWH as outpatient VTE prophylaxis were compared with those who received aspirin due to an inability to afford LMWH. The primary endpoint was the development of symptomatic VTE diagnosed by venous duplex or CT-angiography within the first thirty days from discharge.
Results: Of the 1099 patients initially identified, 712 met inclusion criteria and comprised the study population. Patients receiving aspirin (n=187) rather than LMWH (n = 525) were younger (38.99 vs. 42.88 years old, p = 0.012), more likely to be male (78.61% vs. 63.62%, p < 0.0001), and spent less time in the hospital (5.8 days vs. 7.6 days, p = 0.001). Otherwise, groups were comparable in terms of most comorbidities, mechanism of injury, presenting vitals, lower extremity injury severity score, and rates of in-hospital complications. 1.59% (3) of the patients receiving aspirin developed a symptomatic VTE during the first thirty days following discharge, compared with 1.52% (8) who developed symptomatic VTE (p = 0.93) while receiving LMWH.
Conclusion: In this retrospective review, aspirin was found to be noninferior to LMWH for preventing symptomatic VTE in patients requiring surgical intervention for lower extremity trauma. Future research should be conducted to evaluate aspirin’s potential role as a safe, effective, and affordable alterative to LMWH for extended VTE prophylaxis.