Patients who have surgery to repair bone fractures typically receive a type of injectable blood thinner, low-molecular-weight heparin, to prevent life-threatening blood clots.
Clots are tangles of molecules and blood cells that clump together. They help prevent blood loss when the skin breaks open. They also help stop infections from getting inside the body.
But when clotting happens inside a blood vessel, it can be dangerous.
In a study from the University of Maryland, scientists found that over-the-counter aspirin is just as effective.
The findings could cause surgeons to change their practice and administer aspirin instead to these patients.
Blood clots cause as many as 100,000 deaths in the U.S. each year, according to the U.S. Centers for Disease Control (CDC).
Patients who experience fractures that require surgery—an estimated 1 million people in the U.S. annually—are at increased risk of developing blood clots in the veins, including a fatal pulmonary embolism, which is a clot in the lung.
Current guidelines recommend prescribing low-molecular-weight heparin (enoxaparin), although research in total joint replacement surgery suggested a potential benefit of aspirin as a less-expensive, widely available option.
In the study, the team tested more than 12,000 patients with leg or arm fractures that necessitated surgery or pelvic fractures regardless of the specific treatment.
Half were assigned to receive 30 mg of injectable low-molecular-weight heparin twice daily. The other half received 81 mg of aspirin twice daily. The follow-up period after surgery was 90 days.
The main finding of the study was that aspirin was “noninferior,” or no worse, than low-molecular-weight heparin in preventing death from any cause—47 patients in the aspirin group died compared with 45 patients in the heparin group.
The incidence of bleeding complications and all other safety outcomes was similar in both groups.
Of all the outcomes studied, the one potential difference noted was fewer blood clots in the legs in the low-molecular-weight heparin group.
This relatively small difference was driven by clots lower in the leg, which are of unclear clinical importance.
The team says with data from more than 12,000 patients, this study provides clear evidence that aspirin is a viable option for preventing blood clots in the lung and death in patients who require surgery for orthopedic trauma.
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The study was conducted by Robert V. O’Toole et al and presented at the Orthopedic Trauma Association (OTA) annual meeting
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