Correspondence  |   August 2017
In Reply
Author Notes
  • McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (J.W.E.). eikelbj@mcmaster.ca
  • (Accepted for publication May 8, 2017.)
    (Accepted for publication May 8, 2017.)×
Article Information
Correspondence
Correspondence   |   August 2017
In Reply
Anesthesiology 8 2017, Vol.127, 401-402. doi:10.1097/ALN.0000000000001729
Anesthesiology 8 2017, Vol.127, 401-402. doi:10.1097/ALN.0000000000001729
Gordon comments on the importance of platelets in the propagation of venous thrombosis and suggests that this may explain our findings,1  that aspirin is more effective in preventing large versus small thrombi. He also expresses concern about the widespread use of anticoagulant prophylaxis because of the risk of bleeding, infection, and other serious complications, such as heparin-induced thrombocytopenia. We agree that critical reevaluation of benefits and risks of pharmacologic prophylaxis and in particular the use of anticoagulant compared with aspirin prophylaxis is warranted. The Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement trial currently ongoing in the United States is comparing aspirin plus intermittent pneumatic compression, low-intensity warfarin, and rivaroxaban for prevention of venous thromboembolism in 25,000 patients undergoing elective total hip or total knee replacement (clinicaltrials.gov No. NCT02810704). The results of this trial are expected in 2021.
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