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https://swslhd.intersearch.com.au/swslhdjspui/handle/1/12709| Title: | Aspirin or enoxaparin for VTE prophylaxis after primary partial, total or revision hip or knee arthroplasty: A secondary analysis from the CRISTAL cluster randomized trial |
| Authors: | Sidhu, V. Kelly, T. L. Pratt, N. Graves, S. E. Buchbinder, R. Adie, S. Cashman, K. Ackerman, I. N. Bastiras, D. Brighton, R. Burns, A. W. R. Chong, B. H. Jentz, H. Cripps, M. Dekkers, M. de Steiger, R. Dixon, M. Ellis, A. Griffith, E. C. Hale, D. Hansen, A. Harris, A. Hau, R. Horsley, M. James, D. Khorshid, O. Kuo, L. Lewis, P. Lieu, D. Lorimer, M. Macdessi, S. McCombe, P. McDougall, C. Mulford, J. Naylor, J. M. Page, R. S. Radovanovic, J. Solomon, M. Sorial, R. Summersell, P. Tran, P. Walter, W. L. Webb, S. Wilson, C. Wysocki, D. Harris, I. A. |
| SWSLHD Author: | Lieu, David |
| Affiliates: | School of Clinical Medicine, UNSW Medicine & Health, South West Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Australia Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, SA, Australia Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, SA, Australia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, NSW, Australia South Australian Health and Medical Research Institute, Adelaide, SA, Australia Orthopaedic Department, Westmead Private Hospital, Westmead, Sydney, NSW, Australia Orthopaedic Department, Lakeview Private Hospital, Baulkham Hills, Sydney, NSW, Australia Orthopaedic Department, Calvary John James Hospital, Deakin, ACT, Australia Orthopaedic Department, Calvary John James Hospital, Canberra, NSW, Australia Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia Department of Hematology, New South Wales Pathology, Kogarah Campus, Sydney, NSW, Australia Musculoskeletal Australia, Melbourne, VIC, Australia Orthopaedic Department, Greenslopes Private Hospital, Greenslopes, Brisbane, QLD, Australia Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, VIC, Australia Orthopaedic Department, Kareena Private Hospital, Sutherland, Sydney, NSW, Australia Orthopaedic Department, Royal North Shore Hospital, St Leonard?s, Sydney, NSW, Australia Sydney Musculoskeletal Health Flagship Centre, The University of Sydney, Royal North Shore Hospital, St Leonard?s, Sydney, NSW, Australia Orthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, Sydney, NSW, Australia Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia Orthopaedic Department, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia Bendigo Healthcare Group, Bendigo Hospital, Bendigo, VIC, Australia Orthopaedic Department, Fremantle Hospital, Fremantle, Perth, WA, Australia Orthopaedic Department, Canterbury Hospital, Canterbury, Sydney, NSW, Australia Orthopaedic Department, Calvary Hospital, Adelaide, SA, Australia Orthopaedic Department, Fairfield Hospital, Fairfield, Sydney, NSW, Australia Orthopaedic Department, St George Private Hospital, Kogarah, Sydney, NSW, Australia Orthopaedic Department, Frankston Hospital, Frankston, Melbourne, VIC, Australia Orthopaedic Department, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia Orthopaedic Department, Launceston General Hospital, Launceston, TAS, Australia School of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Australia Orthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, QLD, Australia Orthopaedic Department, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia Orthopaedic Department, Nepean Hospital, Nepean, Sydney, NSW, Australia Orthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, NSW, Australia Orthopaedic Department, Western Health, Melbourne, VIC, Australia The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, The Northern Sydney Local Health District, Sydney, NSW, Australia Orthopaedic Department, Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia Department of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Orthopaedic Department, Sir Charles Gardiner Hospital, Perth, WA, Australia Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia |
| Department: | Fairfield Hospital, Department of Orthopaedics |
| Issue Date: | 2024 |
| Journal: | PLoS ONE |
| Publisher: | Public Library of Science |
| Abstract: | Background This study compares aspirin to enoxaparin for symptomatic VTE prophylaxis within 90 days of any type of hip or knee arthroplasty performed for any diagnosis, in patients enrolled in the CRISTAL trial. Materials and methods CRISTAL was a cluster-randomised crossover, registry-nested non-inferiority trial across 31 hospitals in Australia. The primary publication was restricted to patients undergoing primary total hip or knee arthroplasty for a diagnosis of osteoarthritis. This report includes all enrolled patients undergoing hip or knee arthroplasty procedures (partial or total, primary or revision) performed for any indication. Hospitals were randomized to administer patients aspirin (100mg daily) or enoxaparin (40mg daily), for 35 days after hip arthroplasty and 14 days after knee arthroplasty. Crossover occurred after the patient enrolment target had been met for the first group. The primary outcome was symptomatic VTE within 90 days. Analyses were performed by randomization group. Results Between April 20, 2019 and December 18, 2020, 12384 patients were enrolled (7238 aspirin group and 5146 enoxaparin). Of these, 6901 (95.3%) given aspirin and 4827 (93.8%) given enoxaparin (total 11728, 94.7%) were included in the final analyses. Within 90 days, symptomatic VTE occurred in 226 (3.27%) aspirin patients and 85 (1.76%) enoxaparin patients, significant for the superiority of enoxaparin (estimated treatment difference 1.85%, 95% CI 0.59% to 3.10%, p = 0.004). Joint-related reoperation within 90 days was lower in the enoxaparin group (109/4827 (2.26%) vs 171/6896 (2.47%) with aspirin, estimated difference 0.77%; 95% CI 0.06% to 1.47%, p = 0.03). There were no significant differences in the other secondary outcomes. Conclusion In patients undergoing hip or knee arthroplasty (of any type, performed for any indication) enrolled in the CRISTAL trial, aspirin compared to enoxaparin resulted in a significantly higher rate of symptomatic VTE and joint-related reoperation within 90 days. These findings extend the applicability of the CRISTAL trial results. � 2024 The CRISTAL Study Group. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
| URI: | https://swslhd.intersearch.com.au/swslhdjspui/handle/1/12709 |
| ISSN: | 19326203 (ISSN) |
| Digital object identifier: | 10.1371/journal.pone.0298152 |
| Appears in Collections: | Fairfield Hospital |
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