Here’s a look at aspirin and heparin for blood clot prevention in fracture patients.
Why give the patient heparin if aspirin can be equally effective at preventing blood clots, right?
This was the thought of researchers at University of Maryland School of Medicine. IS aspirin better than heparin?
The study is planned for five years (hopefully the conclusion will be in 2021) and will encompass 13,000 fracture patients; the biggest study of its kind to date.
Currently, the answer to the question of aspirin vs. heparin for preventing blood clots in fracture patients is not definitively known as far as hardcore scientific proof, though some orthopedic surgeons swear by aspirin therapy (like my mother’s hip fracture surgeon) while others will lean towards post-op heparin administration (which must be injected).
Another alternative is prescription Coumadin. Often, the determination is largely based on the particular physician’s approach.
“The only benefit of aspirin may be a decreased bleeding risk — but in general, physicians feel that unless there is a very high bleeding risk, that some form of Heparin or a direct oral anticoagulant (Eliquis/Xarelto) is better,” says Steve Elias, MD, FACS, director of Center for Vein Disease and The Wound Healing Center at Englewood Hospital and Medical Center in Englewood, NJ.
How will the study be done?
- Half the patients will receive aspirin and half the injected heparin.
- The development of blood clots (deep vein thromboses) will be tracked.
Why not just play it super safe and give a fracture patient both aspirin and heparin?
• Heparin increases the risk of internal bleeding more so than does aspirin.
• Many patients may not be at ease with self-injections.
Currently, it’s just not known which drug is better, if one even IS better, than the other.
How does a blood clot lead to death?
• The DVT usually forms in the leg.
• All of it or a piece of it dislodges from its original location and travels to the lungs—at which point it’s called a pulmonary embolus (veins bring blood to the lungs).
• Depending on the size of the migrated clot material, the pulmonary embolus can kill the patient within minutes.
• The migration can also result in multiple, but small, pulmonary emboli that cause the patient respiratory distress and/or chest pain, but death is not imminent in such a case.
• How small or big a pulmonary embolus is or how many there are cannot be determined by the symptoms!
• Suspicion of a pulmonary embolus or even a DVT warrants emergency medical treatment.
In addition to aspirin or heparin for the prevention of blood clots, patients while at the hospital are treated with pneumatic compression devices on their lower legs to keep the blood circulating.