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Updated: Dec 12, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Persistent Wound Drainage among Total Joint Arthroplasty Patients Receiving Aspirin vs Coumadin
Vishavpreet Singh1, Alisina Shahi2, Usama Saleh3
1Oliashirazi Institute at Marshall University, Huntington, WV.
Insights
Aspirin (ASA) significantly reduces persistent wound drainage (PWD) after hip and knee replacement compared to Coumadin, without increasing venous thromboembolism (VTE) risk. Coumadin is an independent risk factor for PWD.
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Infectious Disease Prevention
Background:
- Persistent wound drainage (PWD) is a major risk factor for periprosthetic joint infections (PJI) following total hip (THA) and knee arthroplasty (TKA).
- Evaluating the impact of different venous thromboembolism (VTE) prophylaxis medications on PWD is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the rates of PWD in THA and TKA patients receiving aspirin (ASA) versus Coumadin for postoperative VTE prophylaxis.
- To identify independent risk factors associated with PWD.
Main Methods:
- Retrospective review of 5516 primary THA and TKA cases.
- Comparison of PWD, 30-day VTE, and 6-month PJI incidence between ASA and Coumadin groups using Chi-square tests.
- Multivariate regression analysis to determine independent risk factors for PWD, adjusting for comorbidity indexes.
Main Results:
- The overall prevalence of PWD was 6.4%.
- ASA group showed a significantly lower PWD incidence (3.2%) compared to the Coumadin group (8.5%) (P < .0001).
- Comparable rates of 30-day VTE and 6-month PJI were observed between the groups. Independent risk factors for PWD included diabetes, rheumatoid arthritis, morbid obesity, chronic alcohol use, hypothyroidism, and Coumadin use.
Conclusions:
- Aspirin (ASA) is associated with significantly lower PWD rates after THA and TKA compared to Coumadin.
- ASA demonstrates comparable VTE prevention efficacy to Coumadin.
- Coumadin is identified as an independent risk factor for PWD, suggesting potential benefits of ASA in reducing this complication.
Background:
Persistent wound drainage (PWD) is one of the major risk factors for periprosthetic joint infections (PJI), arguably the most dreaded complications after a total hip and knee arthroplasty (THA and TKA). The aim of this study is to identify the rates of PWD among THA and TKA patients who received aspirin (ASA) or Coumadin for postoperative venous thromboembolism (VTE) prophylaxis.
Methods:
Retrospective review of 5516 primary THA and TKA was performed. Patients with PWD were identified. Chi-square test was used to compare the incidences of PWD, 30-day VTE, and PJI at 6 months between the ASA and Coumadin groups. Multivariate regression model was used to identify independent risk factors for PWD using Charlson and Elixhauser comorbidity indexes.
Results:
The prevalence of PWD was 6.4% (353/5516). Patients receiving ASA had lower incidence of PWD (3.2% vs 8.5%, P < .0001) while having comparable rates of 30-day VTE (1.3% vs 1.4%, P = .722) and PJI at 6 months (1.8% vs 1.4%, P = .233) compared to those receiving Coumadin. Risk factors for PWD were diabetes (odds ratio [OR], 19.3; 95% confidence interval [CI], 11.8-23.2), rheumatoid arthritis (OR, 15.3; 95% CI, 10.8-17.2), morbid obesity (OR, 13.2; 95% CI, 9.7-17.5), chronic alcohol use (OR, 3.5; 95% CI, 1.8-5.5), hypothyroidism (OR, 1.9; 95% CI, 1.1-3.2), and Coumadin (OR, 1.7; 95% CI, 1.2-2.2).
Conclusion:
Use of ASA is associated with significantly lower rates of PWD after THA and TKA when compared to Coumadin while being equally efficacious at preventing VTE. Coumadin was found to be an independent risk factor for PWD.
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