Using Aspirin for DVT Chemoprophylaxis Increases Non-Unions

“The study shows that taking aspirin to decrease deep vein thrombosis (DVT) in tibial shaft and distal plafond fractures:

  • Does not decrease DVT.
  • Increases non-union incidence significantly.
  • Slows cortex union in those fractures that do heal.

Cigarette smoking, diabetes, and type of fracture did not significantly affect any outcome measure.  These complications are statistically significant. Do not take aspirin to prevent DVT secondary to a lower leg fracture. The bold emphasis is mine.” Bill Chesnut, MD.

 Using Aspirin for DVT Chemoprophylaxis Increases Non-Unions in Tibial Shaft, Plafond Fractures__DG News online _March 3, 2016__By Jill Stein

ORLANDO, Fla — March 3, 2016 — Using aspirin for deep vein thrombosis (DVT) and pulmonary embolism (PE) chemoprophylaxis for tibial shaft and plafond fractures delays fracture healing and increases non-unions, according to a study presented here on March 1 at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

John P. Eggers, MD, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, and colleagues examined the medical records of 162 patients who received their index treatment for tibial shaft and plafond fractures over a recent 9-year period at a single centre. Patients were skeletally mature at the time of their injury and their fracture was non-pathologic.

While patients frequently receive chemoprophylactic anticoagulation for prevention of DVTs and PEs for tibial and plafond fractures, aspirin’s effects on non-unions and delayed healing for these fractures have not been previously studied in humans, noted Dr. Eggers said.

Overall, 104 patients received aspirin, while 58 patients did not receive aspirin. Results showed that tibial shaft and plafond non-unions occurred in 19% of patients in the aspirin group compared with 6% of patients in the non-aspirin group. Composite events occurred in 42% and 20% of the 2 groups, respectively.

Aspirin, compared with no-aspirin, significantly increased non-unions (P = .04) and composite events (P = .01).

Open tibial shaft and plafond fractures had significantly increased delayed unions (P = .004) and composite events (P = .023) compared with closed fractures.

Cigarette smoking, diabetes, and type of fracture did not significantly affect any outcome measure.

There was no statistical difference in DVT formation between aspirin and other forms of anti-coagulation.

Excluding non-unions, mean radiographic healing of 3 cortices comparing aspirin and no aspirin was 133 and 96 days (P ˂ .01), respectively.

Dr. Eggers acknowledged that the study had multiple limitations. For example, the study was a retrospective review that used an electronic medical record (EMR) with multiple treating physicians. Patients who were prescribed medication outside the EMR may have received medication that could not be reviewed.

In addition, several patients were lost to follow-up, although loss to follow-up was equal in the 2 groups.

The researchers recommend that physicians use an alternative to aspirin for DVT and PE chemoprophylaxis for tibial shaft and plafond fractures due to aspirin’s deleterious effects on healing.

[Presentation title: Aspirin Utilized for DVT Chemoprophylaxis Increases Non-Unions in Tibial Shaft and Plafond Fractures. Abstract P525]