Hip Pelvis.  2019 Jun;31(2):82-86. 10.5371/hp.2019.31.2.82.

Preoperative Temporary Discontinuation of Aspirin Medication Does Not Increase the Allogeneic Transfusion Rate and Blood Loss in Primary Total Hip Arthroplasty

• Cho MR
• Jun CM
• Choi WK

• KMID: 2448026
• DOI: http://doi.org/10.5371/hp.2019.31.2.82

Abstract

PURPOSE
This study aims to determine whether preoperative temporary discontinuation of aspirin (100 mg/d) use is a safe procedure does not increase blood loss and the need for transfusion after total hip arthroplasty (THA).
MATERIALS AND METHODS
This study retrospectively reviewed 219 patients who underwent consecutive primary THA from January 2012 to December 2018. They were divided into the experimental group (42 cases) that discontinued aspirin intake 7 days before surgery and the control group (150 cases) that had no history of use of antiplatelet agents. To compare initial blood loss between the two groups, we analyzed the changes hemoglobin (Hb) levels and hematocrit values measured preoperatively and in lowest values measured during three days after surgery. In addition, transfusion rate was compared within the first two postoperative weeks between the two groups. A multiple logistic regression was performed to assess the association of transfusion with age, gender, use of antiplatelet agents, preoperative anesthetic risk, body weight and preoperative Hb.
RESULTS
No statistically significant difference was found in the changes in lowest Hb level (P=0.30) and hematocrit value (P=0.14) measured preoperatively and for three days after surgery between the experimental group and the control group. There was no statistically significant association between transfusion and the use of antiplatelet agents, and preoperative Hb level was identified as a factor that affected the need for transfusion (odds ratio, 0.427; P=0.001).
CONCLUSION
Preoperative temporary discontinuation of aspirin use for 7 days before surgery did not increase initial blood loss after THA and the need for transfusion in the first two postoperative weeks compared to patients with no history of use of antiplatelet agents.

Keyword

Hip replacement arthroplasty; Blood transfusion; Aspirin

MeSH Terms

Arthroplasty, Replacement, Hip*
Aspirin*
Blood Transfusion
Body Weight
Hematocrit
Humans
Logistic Models
Platelet Aggregation Inhibitors
Retrospective Studies
Aspirin
Platelet Aggregation Inhibitors

Reference

1. Nansseu JR, Noubiap JJ. Aspirin for primary prevention of cardiovascular disease. Thromb J. 2015; 13:38. PMID: 26640414.

2. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e326S–e350S. PMID: 22315266.

3. Mont MA, Jacobs JJ. AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg. 2011; 19:777–778. PMID: 22134210.

4. Meier R, Marthy R, Saely CH, Kuster MS, Giesinger K, Rickli H. Comparison of preoperative continuation and discontinuation of aspirin in patients undergoing total hip or knee arthroplasty. Eur J Orthop Surg Traumatol. 2016; 26:921–928. PMID: 27613165.

5. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983; 58:277–280. PMID: 6829965.

6. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006; 105:198–208. PMID: 16810012.

7. Hart A, Khalil JA, Carli A, Huk O, Zukor D, Antoniou J. Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates. J Bone Joint Surg Am. 2014; 96:1945–1951. PMID: 25471908.

8. Friedman R, Homering M, Holberg G, Berkowitz SD. Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am. 2014; 96:272–278. PMID: 24553882.

9. Lee JH, Han SB. Patient blood management in hip replacement arthroplasty. Hip Pelvis. 2015; 27:201–208. PMID: 27536627.

10. Harker LA. The kinetics of platelet production and destruction in man. Clin Haematol. 1977; 6:671–693. PMID: 912957.

11. Cossetto DJ, Goudar A, Parkinson K. Safety of peri-operative low-dose aspirin as a part of multimodal venous thromboembolic prophylaxis for total knee and hip arthroplasty. J Orthop Surg (Hong Kong). 2012; 20:341–343. PMID: 23255642.

12. Ford I. Coming safely to a stop: a review of platelet activity after cessation of antiplatelet drugs. Ther Adv Drug Saf. 2015; 6:141–150. PMID: 26301068.