Direct thrombin inhibitor (DTI) vs. aspirin in primary total hip and knee replacement using wound ooze as the primary outcome measure. A prospective cohort study

The latest NICE guidance dictates that all patients undergoing lower-limb arthroplasty should be prescribed potent venous thromboembolic (VTE) prophylaxis. However, use of potent anti-thrombotics is likely to lead to increased post-operative wound ooze. Postoperative wound ooze is associated with increased risk of infection. This study used a prospective, consecutive, multi-surgeon sample of 110 patients undergoing primary total hip replacement (THR) and total knee replacement (TKR) prescribed either direct thrombin inhibitor (DTI) (n=51, 26 males: 25 females, age 69 ±18) or aspirin (n=59, 25 males: 34 females, age 69 ± 19). Hospital stay, body mass index (BMI), wound length and patient demographics were documented along with a daily assessment of wound ooze. The use of DTI's was associated with a significant increase in mean days to dryness in both THR (6.2 ± 0.98, 95% C.I. 5.2-7.1) and TKR (6.6 ± 1.89, 95% C.I. 4.7-8.5) compared to aspirin in THR (3.0 ± 1.03, 95% C.I 1.9-4.0) and TKR (3.4 ± 1.21, 95% C.I 2.2-4.6) with p-values of