Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2024

Open Access 01-12-2024 | Low Molecular Weight Heparin | Research

Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction

Authors: Hamidreza Yazdi, Arvin Eslami, Ali Torkaman, Omid Elahifar, Amir Kasaeian, Shaya Alimoghadam, Rojina Alimoghadam, Mansour Abolghasemian

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

Login to get access

Abstract

Objective

The optimal agent for thromboprophylaxis following arthroscopic anterior cruciate ligament reconstruction (ACLR) remains unclear, particularly in patients with a low baseline risk for venous thromboembolism (VTE). This retrospective cohort study aims to compare the effectiveness and safety of aspirin versus low molecular weight heparins (LMWHs) in this specific patient population.

Methods

We analyzed data from patients who underwent ACLR between March 2016 and March 2021, focusing on those with a low risk for VTE. High-risk individuals, identified by factors such as cardiac disease, pulmonary disease, diabetes mellitus, previous VTE, inflammatory bowel disease, active cancer, and a BMI > 40, were excluded (n = 33). Our approach included a thorough review of medical charts, surgical reports, and pre-operative assessments, complemented by telephone follow-up conducted over a 3-month period by a single investigator. We assessed the incidence of symptomatic VTE, including deep vein thrombosis and pulmonary thromboembolism, as the primary outcome. The secondary outcomes included to complications related to the surgery and thromboprophylaxis. Statistical analysis included descriptive statistics, univariate logistic regression models, and calculations of incidence rates.

Result

In our study, 761 patients (761 knees) were included, with 458 (60.18%) receiving aspirin and 303 (39.82%) receiving LMWH. The two groups showed no significant differences in demographic factors except for age. The incidence of VTE was reported at 1.31% (10 individuals). Specifically, five patients in the aspirin group (1.09%) and five patients in the LMWH group (1.65%) developed a symptomatic VTE event (p = 0.53). Additionally, the two groups did not significantly differ in terms of other complications, such as hemarthrosis or surgical site infection (p > 0.05). Logistic regression analysis revealed no statistically significant difference in VTE risk between the two groups.

Conclusion

This study, focusing on isolated ACLR in patients with a low baseline risk for venous thromboembolism, demonstrated that aspirin is equally effective as low molecular weight heparins for VTE prophylaxis following this surgery.

Level of Evidence

III
Appendix
Available only for authorised users
Literature
1.
Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr., Paletta GA Jr. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42(10):2363–70.CrossRefPubMed
2.
Maletis GB, Inacio MC, Funahashi TT. Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med. 2013;41(9):2090–8.CrossRefPubMed
3.
Gaskill T, Pullen M, Bryant B, Sicignano N, Evans AM, DeMaio M. The prevalence of symptomatic deep venous thrombosis and pulmonary Embolism after Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2015;43(11):2714–9.CrossRefPubMed
4.
Janssen RP, Reijman M, Janssen DM, van Mourik JB. Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: a systematic review. World J Orthop. 2016;7(9):604–17.CrossRefPubMedPubMedCentral
5.
Bokshan SL, DeFroda SF, Panarello NM, Owens BD. Risk factors for deep vein thrombosis or pulmonary Embolus following anterior Cruciate Ligament Reconstruction. Orthop J Sports Med. 2018;6(6):2325967118781328.PubMedPubMedCentral
6.
Kraus Schmitz J, Lindgren V, Janarv P, Forssblad M, Stålman A. Deep venous thrombosis and pulmonary embolism after anterior cruciate ligament reconstruction: incidence, outcome, and risk factors. Bone Joint J. 2019;101–b(1):34–40.CrossRefPubMed
7.
Traven SA, Farley KX, Gottschalk MB, Goodloe JB, Woolf SK, Xerogeanes JW, Slone HS. Combined oral contraceptive use increases the risk of venous thromboembolism after knee arthroscopy and Anterior Cruciate Ligament Reconstruction: an analysis of 64,165 patients in the Truven database. Arthroscopy. 2021;37(3):924–31.CrossRefPubMed
8.
Reynolds AW, Garay M, Lynch S, Black KP, Gallo RA. Incidence of venous thromboembolism following knee arthroscopy: effectiveness of a risk-based stratified Chemoprophylaxis Protocol. J Knee Surg. 2022;35(4):443–8.CrossRefPubMed
9.
Nagashima MOT, Takeshima K, Seki H, Nakayama M, Origuchi N, Ishii K. Unexpectedly high incidence of venous thromboembolism after arthroscopic anterior cruciate ligament reconstruction: prospective, observational study. J ISAKOS. 2020;5(2):2.CrossRef
10.
Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat AS, Thakkar S, Parikh S, Musahl V, Joglekar S, et al. Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts. Knee Surg Sports Traumatol Arthrosc. 2022;30(11):3634–43.CrossRefPubMedPubMedCentral
11.
Cancienne JM, Diduch DR, Werner BC. High Altitude is an independent risk factor for postoperative symptomatic venous thromboembolism after knee arthroscopy: a matched case-control study of Medicare patients. Arthroscopy. 2017;33(2):422–7.CrossRefPubMed
12.
Holler JT, Salesky M, Halvorson RT, Zhang AL, Ma CB, Feeley BT, Leavitt AD, Colyvas N, Lansdown DA. Perioperative Thromboprophylaxis Is Associated With Lower Risk of Venous Thromboembolism After Knee Arthroscopy. Arthroscopy 2022.
13.
Sun Y, Chen D, Xu Z, Shi D, Dai J, Qin J, Jiang Q. Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: a retrospective study with routinely applied venography. Arthroscopy. 2014;30(7):818–22.CrossRefPubMed
14.
Tyson JJ, Bjerke BP, Genuario JW, Noonan TJ. Thromboembolic events after arthroscopic knee surgery: increased risk at high elevation. Arthroscopy. 2016;32(11):2350–4.CrossRefPubMed
15.
Keller RA, Moutzouros V, Dines JS, Bush-Joseph CA, Limpisvasti O. Deep venous thrombosis Prophylaxis in Anterior Cruciate Ligament reconstructive surgery: what is the current state of practice? Sports Health. 2018;10(2):156–9.CrossRefPubMed
16.
Zhu J, Jiang H, Marshall B, Li J, Tang X. Low-molecular-weight heparin for the Prevention of venous thromboembolism in patients undergoing knee arthroscopic surgery and Anterior Cruciate Ligament Reconstruction: a Meta-analysis of Randomized controlled trials. Am J Sports Med. 2019;47(8):1994–2002.CrossRefPubMed
17.
Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S, Vécsei V. Extended-duration Thromboprophylaxis with Enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy: J Arthroscopic Relat Surg. 2007;23(7):696–702.CrossRef
18.
Recommendations from the ICM-VTE. Sports. J Bone Joint Surg Am. 2022;104(Suppl 1):267–79.CrossRef
19.
Kaye ID, Patel DN, Strauss EJ, Alaia MJ, Garofolo G, Martinez A, Jazrawi LM. Prevention of Venous Thromboembolism after Arthroscopic Knee Surgery in a Low-Risk Population with the Use of Aspirin. A Randomized Trial. Bull Hosp Jt Dis (2013) 2015, 73(4):243–248.
20.
Samama CM, Gafsou B, Jeandel T, Laporte S, Steib A, Marret E, Albaladejo P, Mismetti P, Rosencher N. [French Society of Anaesthesia and Intensive Care. Guidelines on perioperative venous thromboembolism prophylaxis. Update 2011. Short text]. Ann Fr Anesth Reanim. 2011;30(12):947–51.CrossRefPubMed
21.
Müller-Rath R, Ingenhoven E, Mumme T, Schumacher M, Miltner O. Perioperatives Management in Der Ambulanten Arthroskopischen Chirurgie Des Kniegelenks. Z Orthop Unfall. 2010;148(03):282–7.CrossRefPubMed
22.
Grant PJ, Greene MT, Chopra V, Bernstein SJ, Hofer TP, Flanders SA. Assessing the Caprini score for Risk Assessment of venous thromboembolism in Hospitalized Medical patients. Am J Med. 2016;129(5):528–35.CrossRefPubMed
23.
24.
25.
Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, Naidu S, Oklu R. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):276–S284.CrossRef
26.
Groenwold RHH, Dekkers OM. Is it a risk factor, a predictor, or even both? The multiple faces of multivariable regression analysis. Eur J Endocrinol 2023, 188(1).
27.
28.
van Adrichem RA, Nemeth B, Algra A, le Cessie S, Rosendaal FR, Schipper IB, Nelissen R, Cannegieter SC. Thromboprophylaxis after knee arthroscopy and Lower-Leg casting. N Engl J Med. 2017;376(6):515–25.CrossRefPubMed
29.
Perrotta C, Chahla J, Badariotti G, Ramos J. Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database Syst Rev. 2020;5(5):Cd005259.PubMed
30.
Forlenza EM, Parvaresh KC, Cohn MR, Lavoie-Gagne O, Khazi ZM, Lu Y, Cregar W, Forsythe B. Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2022;30(5):1552–9.CrossRefPubMed
31.
Sun Y, Chen D, Xu Z, Shi D, Dai J, Qin J, Qin J, Jiang Q. Deep venous thrombosis after knee arthroscopy: a systematic review and meta-analysis. Arthroscopy. 2014;30(3):406–12.CrossRefPubMed
32.
Chapelle C, Rosencher N, Jacques Zufferey P, Mismetti P, Cucherat M, Laporte S. Prevention of venous thromboembolic events with low-molecular-weight heparin in the non-major orthopaedic setting: meta-analysis of randomized controlled trials. Arthroscopy. 2014;30(8):987–96.CrossRefPubMed
33.
Ding J, Yue X, Tian X, Liao Z, Meng R, Zou M. Association between inflammatory biomarkers and venous thromboembolism: a systematic review and meta-analysis. Thromb J. 2023;21(1):82.CrossRefPubMedPubMedCentral
34.
Hu J, Cai Z, Zhou Y. The Association of Neutrophil–lymphocyte ratio with venous thromboembolism: a systematic review and Meta-analysis. Clin Appl Thromb Hemost. 2022;28:10760296221130061.CrossRefPubMedPubMedCentral
35.
Seo WW, Park MS, Kim SE, Lee JH, Park DG, Han KR, Oh DJ, Hyon MS. Neutrophil-lymphocyte ratio as a predictor of venous thromboembolism after total knee replacement. J Knee Surg. 2021;34(2):171–7.CrossRefPubMed
36.
Phan T, Brailovsky Y, Fareed J, Hoppensteadt D, Iqbal O, Darki A. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios Predict all-cause mortality in Acute Pulmonary Embolism. Clin Appl Thromb Hemost. 2020;26:1076029619900549.CrossRefPubMedPubMedCentral
37.
Gong P, Liu Y, Gong Y, Chen G, Zhang X, Wang S, Zhou F, Duan R, Chen W, Huang T, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflamm. 2021;18(1):51.CrossRef
38.
Efe E, Kocayiğit I, Türker PM, Murat K, Erkan A, Sedat T, Alper Ç, Necati AM, Gökhan VM, Bahri A. Platelet-to-lymphocyte ratio but not neutrophil-to-lymphocyte ratio predicts high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndrome. Indian J Pharmacol. 2016;48(4):355–9.CrossRefPubMedPubMedCentral
39.
Santoro L, Ferraro PM, Nesci A, D’Alessandro A, Macerola N, Forni F, Tartaglione R, De Vitis R, Gasbarrini A, Santoliquido A. Neutrophil-to-lymphocyte ratio but not monocyte-to-HDL cholesterol ratio nor platelet-to-lymphocyte ratio correlates with early stages of lower extremity arterial disease: an ultrasonographic study. Eur Rev Med Pharmacol Sci. 2021;25(9):3453–9.PubMed
40.
McIntire SC, Bernstein EM, Tompane TM, Briggs AM, Ferris WJ, Renninger CH, McDonald LS, Hurvitz AP. Aspirin for deep-venous thrombosis Prophylaxis after Anterior Cruciate Ligament Reconstruction. Mil Med. 2021;186(7–8):656–60.CrossRefPubMed
41.
Sandler DA, Martin JF, Duncan JS, Blake GM, Ward P, Ramsay LE, Lamont AC, Ross B, Sherriff S, Walton L. Diagnosis of deep-vein thrombosis: comparison of clinical evaluation, ultrasound, plethysmography, and venoscan with X-ray venogram. Lancet. 1984;2(8405):716–9.CrossRefPubMed
42.
Chopard R, Albertsen IE, Piazza G. Diagnosis and treatment of lower extremity venous thromboembolism: a review. JAMA. 2020;324(17):1765–76.CrossRefPubMed
43.
Bikdeli B, Caraballo C, Trujillo-Santos J, Galanaud JP, di Micco P, Rosa V, Cusidó GV, Schellong S, Mellado M, Del Valle Morales M, et al. Clinical presentation and short- and long-term outcomes in patients with isolated distal deep vein thrombosis vs proximal deep vein thrombosis in the RIETE Registry. JAMA Cardiol. 2022;7(8):857–65.CrossRefPubMedPubMedCentral
44.
Lazo-Langner A, Liu K, Shariff S, Garg AX, Ray JG. Immigration, region of origin, and the epidemiology of venous thromboembolism: a population-based study. Res Pract Thromb Haemost. 2018;2(3):469–80.CrossRefPubMedPubMedCentral
Metadata
Title
Aspirin is as effective as low molecular weight heparins in preventing symptomatic venous thromboembolism following arthroscopic anterior cruciate ligament reconstruction
Authors
Hamidreza Yazdi
Arvin Eslami
Ali Torkaman
Omid Elahifar
Amir Kasaeian
Shaya Alimoghadam
Rojina Alimoghadam
Mansour Abolghasemian
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-024-07282-8

Other articles of this Issue 1/2024

BMC Musculoskeletal Disorders 1/2024 Go to the issue

Research

Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study

Research

Improving patients’ experiences of diagnosis and treatment of vertebral fracture: co-production of knowledge sharing resources

Research

Platelet-rich plasma alleviates neuropathic pain in osteoarthritis by downregulating microglial activation

Research

Biobased polyester versus synthetic fiberglass casts for treating stable upper limb fractures in children: a randomized controlled trial

Research

Ultrasonic bone curette-assisted unilateral approach for bilateral decompression with MIS-TLIF for severe lumbar spinal stenosis

Research

Association of type 2 Diabetes Mellitus and bone mineral density: a two-sample Mendelian randomization study