Reply to Letter to the Editor

Abstract

Dear Drs Bonilla and Bautista, thank you for your thoughtful comments regarding our article, “Rate of Transfusions Following Total Knee Arthroplasty in Patients Receiving Lovenox or High Dose Aspirin.” First of all, I would like to agree that our statement, “No significant differences in VTE rates were found, indicating that in this small cohort ASA was as effective in the prevention of PE and DVT as Lovenox,” might perhaps be an overstatement. You are absolutely right in that our study was underpowered to truly suggest that conclusion. However, we did acknowledge this limitation by stating, “In addition, the small sample size of the current study is likely underpowered to evaluate VTE complication rates, but this is a common limitation encountered in the current literature.” I would concede that we could have made this statement simpler and clearer. Our study cannot show that aspirin is as effective in preventing deep vein thrombosis (DVT) or pulmonary embolism (PE), it can only show that in this small cohort, the rate of transfusions was significantly higher in the Lovenox group without a significant difference in the rates of DVT or PE that were encountered in either group. Statistically speaking, our study cannot definitively conclude that aspirin is as effective in preventing DVT or PE. However, practically speaking, my rate of clinically diagnosed DVT and PE remain very low with the use of aspirin. The consistency of problems associated with the use of Lovenox remains unacceptably high in my practice. Therefore, except for patients who have an unusually high risk for DVT or PE, I, personally, will never use Lovenox as my primary chemoprophylactic agent in hip or knee arthroplasty cases. Download .pdf (.02 MB) Help with pdf files Conflict of Interest Statement for Nakasone Download .pdf (.82 MB) Help with pdf files Conflict of Interest Statement for Radzak Letter to the Editor on “Rate of Transfusions Following Total Knee Arthroplasty in Patients Receiving Lovenox or High Dose Aspirin”The Journal of ArthroplastyVol. 31Issue 6PreviewWe had the opportunity to read the article by Miller et al [1] addressing the rate of transfusion in patients receiving 2 different regimes of thromboprophylaxis after knee arthroplasty. We acknowledge the authors' endeavor to conduct such an interesting retrospective analysis. They report a remarkable statistically significant difference in both hemoglobin and hematocrit drops and the rate of transfusion between groups. We consider that these findings are also clinically significant as postoperative anemia remains one of the most common complications after major orthopedic surgery [2]. Full-Text PDF