Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2023;11(2):4 JAMA. 2022 Aug 23;328(8):719-727.What this means for my practice?
The results of this study demonstrated the superiority of enoxaparin over aspirin for the prevention of symptomatic venous thromboembolism in osteoarthritis patients undergoing total hip or knee arthroplasty. This study was limited by the 5.2% loss to follow-up, the inclusion of osteoarthritic patients only, and the lack of blinding of hospitals to treatment allocation.
Study Summary
9711 patients with osteoarthritis undergoing a hip or knee arthroplasty procedure at one of 31 participating hospitals were randomized (in this hospital-level, cluster-randomized, crossover, non-inferiority trial) to receive aspirin (n=5675) or enoxaparin (n=4036) for the prevention of symptomatic venous thromboembolism (VTE). The primary outcome of interest was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis. Secondary outcomes included death, major bleeding, readmission, re-operation, and drug adherence. Enoxaparin was superior to aspirin for the primary outcome of symptomatic VTE (p=0.007); in particular, the rate of any deep venous thrombosis and below-knee deep venous thrombosis was significantly higher in the aspirin group. No significant differences in all secondary outcomes were observed between the two groups.
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