Prevention of Thromboembolic Disease in Minimally Invasive Total Hip Arthroplasty With Acetylsalicylic Acid Is Safe, Cost-efficient, and Effective

Abstract

PURPOSE: To evaluate the efficacy and safety of Enteric Coated Acetylsalicylic acid (ECASA) in prevention of deep vein thrombosis (DVT), nonfatal and fatal pulmonary embolism (PE) in primary total hip arthroplasty (THA) via a minimally invasive posterior approach. METHODS: A retrospective analysis of prospectively collected data of a consecutive series of 1202 patients (ages 15-90 years) who underwent THA was performed. Exclusion criteria were previous hip surgery and preoperative anticaogulant therapy. The remaining 546 patients (273 male and 273 female) were analyzed. There were 498 unilateral and 48 bilateral procedures. Surgeries were performed by Drs. Dorr and Long. All patients had knee-high graduated elastic stocking (TEDS) and intermittent compression devices during the duration of the hospital stay. All patients were mobilized weight bearing as tolerated within the first 12 hours after surgery. ECASA therapy was initiated immediately postoperatively. Patients received 325 mg of ECASA therapy twice a day and a proton pump inhibitor daily for one month. All patients were examined with duplex ultrasonography prior to discharge. TED stockings were worn daily for one month. RESULTS: There were two cases of distal DVT below the knee (0.37%) in one male and one female, both in the non-operative leg found prior to discharge. The two distal DVT resolved at one week. There was one pulmonary embolism (0.18%) at day 14 with a negative duplex at discharge. There were no fatalities, no cases of gastrointestinal bleeding and no wound hematomas requiring surgical exploration. All cases were seen in follow-up at 6 weeks and 3 months. CONCLUSION: ECASA is an inexpensive, safe and effective method of prophylaxis against thrombo-embolic disease for primary hip arthroplasty. The use of ECASA combined with TED stockings, intermittent compression devices and early unrestricted mobiliztion produced superior results compared to current recommended practice guidelines by the ACCP. CLINICAL IMPLICATIONS: Patients without increased risk factors for DVT are good candidates for prophylaxis therapy with ECASA combined with TED stockings, in-hospital compression devices and early unrestricted mobilization after minimally invasive posterior THA.