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TRAUMA |
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The use of aspirin has been found to provide adequate thromboprophylaxis in total joint arthroplasties with a more favourable safety profile compared to low molecular weight heparin. However, high-quality evidence in fracture patients has been limited. With a lower cost and an easier administration (oral vs. subcutaneous) with aspirin, a randomized trial was warranted to see whether the benefits could translate into trauma cases.
The PREVENT CLOT Trial randomized 12,211 patients with an extremity fracture (treated operatively) or a fracture of the pelvis or acetabulum (treated operatively or non-operatively) from 21 trauma centers in Canada & the USA to receive either 30mg of low molecular weight heparin twice daily (n=6,110) or 81mg of aspirin twice daily (n=6,101). The primary outcome of interest was death from any cause.
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Aspirin was found to be non-inferior (p<0.001) to low molecular weight heparin for the primary outcome of death from any cause, but was not superior either (p=0.63).
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The incidence of pulmonary embolism events was similar between groups. However, the aspirin group had a higher rate of deep vein thrombosis (DVT) events, in particular, distal DVT cases.
Bottom line. Aspirin was non-inferior to low molecular weight heparin for the prevention of death in fracture patients, but could come with a slightly increased risk of deep vein thrombosis.
Check out the full ACE Report here. |
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Post-operative wound management is an element of the peri-operative process which has become increasingly appreciated by health care providers – an effective dressing can minimize the risk of infection, bleeding, and pain. The silver-impregnated occlusive dressing has demonstrated effectiveness, but can be costly and be of limited availability. The researchers of this study created a new dressing system utilizing calcium alginate, which is low cost and more accessible. But does it work?
124 patients with osteonecrosis of the femoral head or hip osteoarthritis scheduled for a total hip arthroplasty were randomized to receive the novel calcium alginate dressing (n=62) or a traditional gauze dressing (n=62). The primary outcomes of interest included the number of dressing changes, length of stay, wound evaluation, and complications.
• Patients who received the calcium alginate dressing required significantly less dressing changes (p<0.001) and had a shorter length of stay than the control group (p<0.001).
• Cosmetic wound evaluation scores were significantly better in the calcium alginate group compared to the control group (p<0.001).
• No significant difference between groups in wound evaluation scores for infection surveillance were observed.
• Satisfaction levels were significantly higher in the calcium alginate group (p<0.001).
• Pain and functional outcomes were similar between the two groups.
Bottom line. Aspirin was non-inferior to low molecular weight heparin for the prevention of death in fracture patients, but could come with a slightly increased risk of deep vein thrombosis.
Check out the comprehensive analysis of this paper here.
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Elderly hip fracture patients are at a higher risk of complications due to anesthesia. Post-operative delirium is a particularly troublesome complication which can increase the risk of morality, impede recovery, and affect cognition. With neuraxial and general anesthesia being the most common, it was of interest to compare the risk of post-operative delirium between the two methods.
Searching the PubMed, EMBASE, Google Scholar, Cochrane Library, and Web of Science databases, this systematic review included 10 RCTs (3,968 elderly patients undergoing hip fracture surgery) comparing neuraxial anesthesia and general anesthesia. The outcomes of interest included post-operative delirium, neuropsychological outcomes, pain, length of stay, discharge rate, and mortality.
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No significant differences in the odds of post-operative delirium were observed between the two anesthesia methods, immediately post-operation (p=0.37) and up to 7 days post-operation (p=0.17).
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No significant differences between groups were observed in mini-mental state examination scores (p=0.63) or Beck Depression Inventory scores (p=0.22).
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Length of stay, mortality, and discharge to pre-admission residence were similar between groups (p>0.05 for all).
Bottom line. Neuraxial and general anesthesia appear to have comparable effects on post-operative delirium and other post-operative outcomes for elderly patients undergoing hip fracture surgery.
Check out the comprehensive analysis of this paper here. |
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EDITOR’S PICKS |
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Market Analysis: Total Hip Arthroplasty – Total hip arthroplasty (THA) is considered the gold standard treatment for end-stage hip osteoarthritis. The expected rise in THA volume presents a promising opportunity for device manufacturers to enter this burgeoning market. We analyzed the academic market to see where and who is generating the evidence on THA. (Read) |
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Diversity, Mentorship & Patient Expectations – In this OrthoJoe podcast (Ep 72), Mo & Marc sit down with Dr. Margaret Fok, Assistant Professor and orthopaedic surgeon, for a discussion on the importance of diversity, motivating the younger generation, and how to manage patient expectations. (Watch) |
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