Evidence map›Paper›PMID 29292343›Full record

ArticleThe bone & joint journal2018

Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin

R Goel, A N Fleischman, T Tan, E Sterbis, R Huang, C Higuera, J Parvizi, R H Rothman

Open access · greenAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The bone & joint journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
2.1field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.

  1. Pooled it
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  3. Review
  4. Review
  5. Article
  6. Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

R GoelRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
A N FleischmanRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
T TanRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
E SterbisRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
R HuangRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
C HigueraCleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
J ParviziRothman Institute, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
R H RothmanRothman Institute at Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107, USA.
Cleveland Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsThe aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA). PATIENTS AND

methodsA retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk.

resultsThe adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA.

conclusionAspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for those with significant underlying risk factors. Patients should be informed about the risks associated with undergoing SBTKA. Cite this article:

Indexed as

Arthroplasty, Replacement, KneeAdultAgedAged, 80 and overAnticoagulantsAspirinDose-Response Relationship, DrugDrug Administration ScheduleFemaleHumansIncidenceLogistic ModelsMaleMiddle AgedPlatelet Aggregation InhibitorsPostoperative ComplicationsAnticoagulantsAspirinPlatelet Aggregation InhibitorsWarfarinAspirinBilateralKneeTotal Knee ArthroplastyVenous thromboembolism

Identifiers

PMID29292343
PMCPMC6424442
OpenAlexW2793576894

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.