Evidence map›Paper›PMID 37294566›Full record

Trial reportJAMA network open2023

Effect of Aspirin vs Enoxaparin on 90-Day Mortality in Patients Undergoing Hip or Knee Arthroplasty: A Secondary Analysis of the CRISTAL Cluster Randomized Trial.

CRISTAL Study Group, Verinder S Sidhu, Thu-Lan Kelly, Nicole Pratt, Stephen E Graves, Rachelle Buchbinder, Sam Adie, Kara Cashman, Ilana N Ackerman, Durga Bastiras and 37 more

Abstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA network open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 3 pooled it
–field-weighted citation impact
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, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Review
  5. Article
  6. Observational
  7. Article
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

47 authors.

CRISTAL Study Group
Verinder S SidhuSchool of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
Thu-Lan KellyClinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia.
Nicole PrattClinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia.
Stephen E GravesAustralian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.
Rachelle BuchbinderSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Sam AdieSchool of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia.
Kara CashmanSouth Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Ilana N AckermanSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Durga BastirasAustralian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.
Roger BrightonOrthopaedic Department, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia.
Alexander W R BurnsOrthopaedic Department, Calvary John James Hospital, Deakin, Australian Capital Territory, New South Wales, Australia.
Beng Hock ChongDepartment of Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Ornella ClavisiMusculoskeletal Australia, Melbourne, Victoria, Australia.
Maggie CrippsMusculoskeletal Australia, Melbourne, Victoria, Australia.
Mark DekkersOrthopaedic Department, Greenslopes Private Hospital, Greenslopes, Queensland, Australia.
Richard de SteigerDepartment of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia.
Michael DixonOrthopaedic Department, Kareena Private Hospital, Sutherland, New South Wales, Australia.
Andrew EllisOrthopaedic Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Elizabeth C GriffithSouth Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
David HaleOrthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, New South Wales, Australia.
Amber HansenSchool of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
Anthony HarrisCentre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia.
Raphael HauDepartment of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia.
Mark HorsleyOrthopaedic Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Dugal JamesBendigo Healthcare Group, Bendigo Hospital, Bendigo, Victoria, Australia.
Omar KhorshidOrthopaedic Department, Fremantle Hospital, Fremantle, Perth, Western Australia, Australia.
Leonard KuoOrthopaedic Department, Canterbury Hospital, Canterbury, New South Wales, Australia.
Peter L LewisCalvary Adelaide Hospital, Adelaide, South Australia, Australia.
David LieuOrthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia.
Michelle LorimerSouth Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Samuel J MacDessiSchool of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia.
Peter McCombeOrthopaedic Department, Frankston Hospital, Frankston, Victoria, Australia.
Catherine McDougallOrthopaedic Department, The Prince Charles Hospital, Chermside, Queensland, Australia.
Jonathan MulfordOrthopaedic Department, Launceston General Hospital, Launceston, Tasmania, Australia.
Justine Maree NaylorSchool of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
Richard S PageSchool of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Australia.
John RadovanovicOrthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, Queensland, Australia.
Michael SolomonOrthopaedic Department, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Rami SorialOrthopaedic Department, Nepean Hospital, Penrith, New South Wales, Australia.
Peter SummersellOrthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia.
Phong TranOrthopaedic Department, Western Health, Melbourne, Victoria, Australia.
William L WalterOrthopaedic Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Steve WebbAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Chris WilsonOrthopaedic Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.
David WysockiOrthopaedic Department, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia.
Ian A HarrisSchool of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Ischemic heart disease remains the leading cause of mortality following hip and knee arthroplasty. Due to its antiplatelet and cardioprotective properties, aspirin has been proposed as an agent that could reduce mortality when used as venous thromboembolism (VTE) prophylaxis following these procedures. Objective: To compare aspirin with enoxaparin in reducing 90-day mortality for patients undergoing hip or knee arthroplasty procedures. Design, Setting, and Participants: This study was a planned secondary analysis of the CRISTAL cluster randomized, crossover, registry-nested trial performed across 31 participating hospitals in Australia between April 20, 2019, and December 18, 2020. The aim of the CRISTAL trial was to determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE following hip or knee arthroplasty. The primary study restricted the analysis to patients undergoing total hip or knee arthroplasty for a diagnosis of osteoarthritis only. This study includes all adult patients (aged ≥18 years) undergoing any hip or knee arthroplasty procedure at participating sites during the course of the trial. Data were analyzed from June 1 to September 6, 2021. Interventions: Hospitals were randomized to administer all patients oral aspirin (100 mg daily) or subcutaneous enoxaparin (40 mg daily) for 35 days after hip arthroplasty and 14 days after knee arthroplasty procedures. Main Outcomes and Measures: The primary outcome was mortality within 90 days. The between-group difference in mortality was estimated using cluster summary methods. Results: A total of 23 458 patients from 31 hospitals were included, with 14 156 patients allocated to aspirin (median [IQR] age, 69 [62-77] years; 7984 [56.4%] female) and 9302 patients allocated to enoxaparin (median [IQR] age, 70 [62-77] years; 5277 [56.7%] female). The mortality rate within 90 days of surgery was 1.67% in the aspirin group and 1.53% in the enoxaparin group (estimated difference, 0.04%; 95% CI, -0.05%-0.42%). For the subgroup of 21 148 patients with a nonfracture diagnosis, the mortality rate was 0.49% in the aspirin group and 0.41% in the enoxaparin group (estimated difference, 0.05%; 95% CI, -0.67% to 0.76%). Conclusions and Relevance: In this secondary analysis of a cluster randomized trial comparing aspirin with enoxaparin following hip or knee arthroplasty, there was no significant between-group difference in mortality within 90 days when either drug was used for VTE prophylaxis. Trial Registration: http://anzctr.org.au Identifier: ACTRN12618001879257.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneeVenous ThromboembolismAdolescentAdultAgedAspirinEnoxaparinFemaleHumansMaleAspirinEnoxaparin

Identifiers

PMID37294566
PMCPMC10257098

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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.