1. In this randomized objective trial, determination were nary differences successful mortality, pulmonary embolism, oregon information betwixt thromboprophylaxis with aspirin versus low-molecular-weight heparin successful patients with fractures.
2. Incidence of heavy vein thrombosis was higher with aspirin usage compared to low-molecular-weight heparin use.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Thromboprophylaxis therapy is presently recommended to trim decease and complications associated with venous thromboembolism aft fractures. Aspirin is often preferred implicit low-molecular-weight heparin by patients for thromboprophylaxis owed to its little outgo and oral administration. However, determination is paucity successful grounds comparing aspirin and low-molecular-weight heparin treatment. In this randomized objective trial, the efficacy and information of aspirin and low-molecular-weight heparin for thromboprophylaxis attraction were compared successful patients with an extremity, pelvic, oregon acetabulum fracture. Low-molecular-weight heparin was administered subcutaneously astatine a 30 mg dose doubly regular and aspirin was fixed orally astatine an 81 mg dose doubly daily. The duration of thromboprophylaxis ended oregon continued astatine discharge depending connected existing objective protocols of each hospital. Patients were followed for 90 days. Incidence of decease was not importantly antithetic betwixt groups, adjacent aft stratifying by property oregon origin of death. Incidence of nonfatal pulmonary embolism was not importantly antithetic betwixt groups. There were importantly much heavy vein thrombosis occurrences successful the aspirin radical compared to the low-molecular-weight heparin group. Safety outcomes, including bleeding events, coiled complications, heavy surgical-site infections, oregon different superior adverse events, were not importantly antithetic betwixt groups. As limitations, the survey had an open-label plan and determination were differences successful the duration of thromboprophylaxis therapy aft discharge depending connected infirmary protocol.
Click to work the survey successful NEJM
In-Depth [randomized controlled trial]: This randomized controlled objective proceedings compared the efficacy and information of thromboprophylaxis attraction with aspirin and low-molecular-weight heparin successful patients with fractures. Patients implicit the property of 18 with an extremity fracture treated operatively oregon a pelvic oregon acetabulum fracture treated operatively oregon nonoperatively (n = 12,211) were randomized to person aspirin (n = 6,101) oregon low-molecular-weight heparin (n = 6,110). Patients were followed for 90 days. Protocol adherence was 94.7% and 96.9% for the aspirin and low-molecular-weight heparin groups, respectively. The 90-day probability of decease was 0.78% and 0.73% successful the aspirin and low-molecular-weight heparin groups, respectively, and not importantly antithetic betwixt groups. The incidence of nonfatal pulmonary embolism was not importantly antithetic betwixt groups. The 90-day probability of heavy vein thrombosis was importantly higher successful the aspirin radical compared to the low-molecular-weight heparin radical (2.51% and 1.71%; 0.80 percent points difference; 95% Confidence Interval, 0.28 to 1.31). For information outcomes, determination were nary important differences successful bleeding events, coiled complications, heavy surgical-site infections, oregon different superior adverse events betwixt groups. In summary, thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin for the prevention of thromboembolic events successful patients with orthopedic trauma.
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