Aspirin Found to Reduce Complications and Death in Fracture Patients

According to a study published in the New England Journal of Medicine and reported by The Mirage, fracture patients in the hospital are given low-molecular-weight heparin to prevent blood clots. Recent studies, however, have shown that low-cost, over-the-counter aspirin has equivalent effectiveness.  

This is the most extensive study, with over 12,000 orthopedic trauma patients treated at 21 trauma centers in the United States and Canada participating. The collaboration between orthopedic and trauma surgeons emphasizes the necessity for high-quality, head-to-head comparative studies to evaluate postoperative complications such as blood clots and infections.

Researchers from UMSOM’s Department of Orthopaedics and the Johns Hopkins Bloomberg School of Public Health’s Major Extremity Trauma Research Consortium (METRC) collaborated on the study.  

Dr. Robert V. O’Toole, the author of the study and the Hansjörg Wyss Medical Foundation Endowed Professor in Orthopaedic Trauma at UMSOM, expects that “many patients with fractures would likely prefer to take a daily aspirin than obtaining injections.” The findings of this large-scale study are expected to change present ways of care delivery and maybe establish a new gold standard.

The Centers for Disease Control and Prevention estimates that 100,000 Americans die yearly from blood clots (CDC). Fractures that necessitate surgery are linked to an increased risk of blood clots in the lungs and extremities. Lung clots are a potentially lethal disorder. Although guidelines currently recommend low-molecular-weight heparin, aspirin may help avoid these clots (enoxaparin).  

There were 12,211 participants in the study who had pelvic or limb fractures requiring surgery. Half were randomly assigned to receive low molecular weight heparin 30 mg twice daily through injection. Half of them also took 81 mg of aspirin each time. The impact of the two therapies on health was compared after 90 days.  

Aspirin was “non-inferior” too low molecular weight heparin in avoiding all-cause mortality, with 47 deaths in the aspirin group and 45 in the heparin group. Both groups had similar incidences of lung clots (pulmonary embolisms). Both groups had equal rates of bleeding, infection, and wounding.DVT was the only possibly identifiable result. When using aspirin or heparin, 2.5% and 1.7% of patients suffered this adverse effect, respectively.  

Deborah Stein, MD, MPH, co-principal investigator of the study and UMSOM Professor of Surgery and UMMC Director of Adult Critical Care Services, explained that the slight difference was caused by clots lower in the leg, which are generally considered to be of less clinical significance and do not require treatment.  

The independent, non-profit Patient-Centered Outcomes Study Institute (PCORI) supported the $11.7 million research effort.”This large multicenter study was needed to adequately measure the impact of prophylaxis on the infrequent, but important, the outcome of death that is of utmost importance to patients,” said Renan Castillo, Ph.D., Professor of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health and principal investigator of the study’s methods center.  

Patients are not fond of self-injections. “It burns and bruises your stomach faster than aspirin,” Debra Marvel, a 53-year-old patient advisor from Columbia, Maryland, said. “This discovery could help prevent potentially fatal blood clots in these patients by using a medication that is far less expensive and far easier to administer,” said Mark T.

Gladwin, MD, Vice President for Medical Affairs at the University of Maryland, Baltimore, and the John Z. and Akiko K. The importance of these data shows that aspirin may be advised as part of blood clot prevention guidelines for persons with traumatic bone fractures.