A Narrative Review of Aspirin Resistance in VTE Prophylaxis for Orthopaedic Surgery
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REVIEW ARTICLE
A Narrative Review of Aspirin Resistance in VTE Prophylaxis for Orthopaedic Surgery Nameer van Oosterom1,2,3 · Michael Barras1,2 · Robert Bird4 · Iulian Nusem5,6 · Neil Cottrell1
© Springer Nature Switzerland AG 2020
Abstract Total hip arthroplasties (THA) and total knee arthroplasties (TKA) confer one of the highest risks for developing venous thromboembolism (VTE) and pharmacological prophylaxis is imperative to help mitigate the risks. Aspirin is the most cost-effective medication for VTE prophylaxis, and its use post-THA/TKA has grown in popularity. Aspirin resistance is categorised as clinical or laboratory resistance with obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases identified as risk factors for aspirin resistance. Treatment failure due to aspirin resistance has been reported in cardiovascular and cerebrovascular disease leading to increased rates of mortality and re-embolisation. However, aspirin resistance in patients undergoing a THA/TKA has not been described, nor has there been investigation into the incidence rates or clinical outcomes. The aim of this narrative review is to appraise the concept of aspirin resistance in the context of aspirin use for VTE prophylaxis after THA/TKA surgeries. This is important to investigate as the risk factors for aspirin resistance, including obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases, are also risk factors for THA/TKA and risk factors for VTE. The presence of aspirin resistance in patients undergoing orthopaedic surgery may place patients at greater risk of thrombotic events if aspirin is prescribed for VTE prophylaxis. This could further increase the risk of complications associated with VTE and potential long-term consequences such as post-thrombotic syndrome. Future research is required to explore and quantify the rates of aspirin resistance and the clinical outcomes in orthopaedic patients; especially in those patients with these overlapping risk factors for THA/TKA, VTE and aspirin resistance.
Key Points
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40265-020-01413-w) contains supplementary material, which is available to authorized users. * Nameer van Oosterom [email protected] 1
School of Pharmacy, University of Queensland, Brisbane, Australia
2
Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia
3
Pharmacy Department, Logan Hospital, Brisbane, Australia
4
Department of Haematology, Princess Alexandra Hospital, Brisbane, Australia
5
Department of Orthopaedic Surgery, Logan Hospital, Brisbane, Australia
6
School of Medicine, Griffith University, Gold Coast, Australia
Aspirin is an accepted agent for venous thromboembolism prophylaxis after total hip or knee arthroplasties. Aspirin resistance has been seen in cardiovascular and neurovascular diseases and has been linked with poorer outcomes. Aspirin resistance has not been investigated after orthopaedic surgery,
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