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Aspirin Noninferior to Low-Molecular-Weight Heparin After Fracture

No significant difference seen in incidence of death, deep vein thrombosis, pulmonary embolism, bleeding complications

By Elana Gotkine HealthDay Reporter

FRIDAY, Jan. 20, 2023 (HealthDay News) — For patients with orthopedic trauma, thromboprophylaxis with aspirin is noninferior to low-molecular-weight heparin for preventing death, according to a study published in the Jan. 19 issue of the New England Journal of Medicine.

Robert V. O’Toole, M.D., from the University of Maryland School of Medicine in Baltimore, and colleagues conducted a randomized, noninferiority trial involving adult patients who had a fracture of an extremity that had been treated operatively or any pelvic or acetabular fracture. Patients were randomly assigned to receive either low-molecular-weight heparin or aspirin while they were in the hospital (6,110 and 6,101 patients, respectively). The patients continued to receive thromboprophylaxis after discharge according to the hospital clinical protocol.

The researchers found that death at 90 days occurred in 0.78 and 0.73 percent of patients in the aspirin and low-molecular-weight heparin groups, respectively (difference, 0.05 percentage points; 96.2 percent confidence interval, −0.27 to 0.38; P < 0.001 for noninferiority). Deep vein thrombosis occurred in 2.51 and 1.71 percent of patients in the aspirin and low-molecular-weight heparin groups, respectively. The groups had a similar incidence of pulmonary embolism, bleeding complications, and other serious adverse events.

“The findings in this trial clearly indicate that guidelines for the prevention of hospital-acquired venous thromboembolism will need to be rewritten to include the option of aspirin in patients with traumatic injuries,” write the authors of an accompanying editorial.

Several authors disclosed financial ties to the medical device and health care industries.

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