Aspirin as good as heparin for thromboprophylaxis in patients with fractures

Thromboprophylaxis with aspirin in patients with extremity fractures appears to prevent death and lower the incidences of deep-vein thrombosis and pulmonary embolism without any significant differences as compared with thromboprophylaxis with low-molecular-weight heparin, according to a study.

The study included 12,211 patients who had a fracture of an extremity (anywhere from hip to midfoot or shoulder to wrist) that had been treated operatively or who had any pelvic or acetabular fracture. While in the hospital, the patients were randomly assigned to receive low-molecular-weight heparin (enoxaparin) 30 mg twice daily (n=6,110) or aspirin 81 mg twice daily (n=6,101). Thromboprophylaxis was continued after hospital discharge.

Overall, the patients had a mean age of 44.6 years. There were 0.7 percent of patients with a history of venous thromboembolism and 2.5 percent with a history of cancer. A mean of 8.8 in-hospital thromboprophylaxis doses and a median 21-day supply of thromboprophylaxis at discharge were given.

The primary outcome of death from any cause at 90 days occurred in 47 patients in the aspirin group and 45 in the heparin group (0.78 percent vs 0.73 percent; difference, 0.05 percentage points, 96.2 percent confidence interval [CI], −0.27 to 0.38; p<0.001 for a noninferiority margin of 0.75 percentage points).

The frequency of deep-vein thrombosis was slightly higher in the aspirin than in the heparin group (2.51 percent vs 1.71 percent; difference, 0.80 percentage points, 95 percent CI, 0.28–1.31). No significant between-group differences were observed in the frequency of pulmonary embolism (1.49 percent in each group), bleeding complications, and other serious adverse events.