Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

Nathan N. O'Hara; Katherine P. Frey; Deborah M. Stein; Joseph F. Levy; Gerard P. Slobogean; Renan Castillo; Reza Firoozabadi; Madhav A. Karunakar; Joshua L. Gary; William T. Obremskey; Rachel B. Seymour; Joseph Cuschieri; C. Daniel Mullins; Robert V. O'Toole; Anthony R. Carlini; Brianna E. Fowler; Tara J. Taylor; Stephen T. Wegener; Elias Weston-Farber; Steven Craig Herndon; Debra Marvel; Gregory J. Jurkovich; Christopher Lee; Ajai K. Malhotra; Matthew D. Riedel; Thomas A. Decoster; Gregory M. Vercellotti; Jeffrey L. Wells; Edward R. Westrick; Michael J. Bosse; A. Britton Christmas; Kyle William Cunningham; Joseph R. Hsu; Toan Huynh; David George Jacobs; Laurence B. Kempton; Stephen H. Sims; Christine Churchill; Eben A. Carroll; Sharon Babcock; Preston R. Miller; Holly T. Pilson; James Brett Goodman; Martha B. Holden; Michael J. Weaver; John G. Esposito; Samuel Z. Goldhaber; Marilyn Heng; Madeline M. McGovern; George C. Velmahos; Arvind Von Keudell; Jessica C. Rivera; Ida Leah Gitajn; Prism S. Schneider; Richard E. Buckley; Jodi Gallant; Paula McKay; Conor P. Kleweno; Julie Agel; Roman M. Natoli; Greg E. Gaski; Carrie L. Heincelman; Yohan Jang; Luke A. Lopas; Todd O. McKinley; Raveesh Daniel Richard; Anthony T. Sorkin; Walter Virkus; Lauren C. Hill; Robert A. Hymes; Michael Holzman; Farhanaz Panjshiri; Jeff E. Schulman; Lolita Ramsey; Jaslynn A.N. Cuff; Elliott R. Haut; Stephen J. Warner; Bryan A. Cotton; Keyla D. Guevara; Jeffrey A. Claridge; Heather A. Vallier; Mary A. Breslin; Daniel Connelly; Qasim M. Ghulam; Bryce E. Haac; Christopher T. Lebrun; Theodore T. Manson; Jason Nascone; Raymond A. Pensy; Andrew N. Pollak; Ugochukwu N. Udogwu; Cynthia Elaine Burke; Yasmin Degani; Genaro A. Deleon; Zachary D. Hannan; Kathleen M. Healey; Andrea L. Howe; Dimitrius P. Marinos; Phillip C. McKegg; Natasha S. McKibben; Nicolas H. Zingas; Andrew R. Evans; Brad M. Askam; Christina Boulton; John C. Weinlein; Patrick F. Bergin; Matthew E. Kutcher; John Morellato; Priyanka V. Nehete; Ugur Yener; Paul S. Whiting; Christopher Domes; Gabrielle R. Kuhn; Vamshi Gajari; Andres Fidel Moreno-Diaz; Elsa B. Rodriguez-Baron; Andres Rodriguez-Buitrago; Daniel J. Stinner; Karen M. Trochez; Peter Depalo; Leah C. Kennedy; Karin Lienhard; Ryan Martin; Stephanie C. Yee; Jordan Leonard; Hikmatullah Arif; Krista Brown; Lakye Lenee Deeter; Neil Sardesai; Abdulai T. Bangura; Haley K. Demyanovich; W. Andrew Eglseder; Jayesh Gupta; Marckenley Isaac; Alexandra Mulliken; M. J. Crisco; Stephanie N. Lueckel; Gregory A. Brown; Stephen Breazeale; Stephen N. Fisher; Jason R. Wild; Michael J. Beebe; Rajinder M. Khanna; Deborah Brauer; Robert H. Boyce

doi:10.2106/JBJS.23.00824

Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

Nathan N. O'Hara, Katherine P. Frey, Deborah M. Stein, Joseph F. Levy, Gerard P. Slobogean, Renan Castillo, Reza Firoozabadi, Madhav A. Karunakar, Joshua L. Gary, William T. Obremskey, Rachel B. Seymour, Joseph Cuschieri, C. Daniel Mullins, Robert V. O'Toole, Anthony R. Carlini, Brianna E. Fowler, Tara J. Taylor, Stephen T. Wegener, Elias Weston-Farber, Steven Craig HerndonDebra Marvel, Gregory J. Jurkovich, Christopher Lee, Ajai K. Malhotra, Matthew D. Riedel, Thomas A. Decoster, Gregory M. Vercellotti, Jeffrey L. Wells, Edward R. Westrick, Michael J. Bosse, A. Britton Christmas, Kyle William Cunningham, Joseph R. Hsu, Toan Huynh, David George Jacobs, Laurence B. Kempton, Stephen H. Sims, Christine Churchill, Eben A. Carroll, Sharon Babcock, Preston R. Miller, Holly T. Pilson, James Brett Goodman, Martha B. Holden, Michael J. Weaver, John G. Esposito, Samuel Z. Goldhaber, Marilyn Heng, Madeline M. McGovern, George C. Velmahos, Arvind Von Keudell, Jessica C. Rivera, Ida Leah Gitajn, Prism S. Schneider, Richard E. Buckley, Jodi Gallant, Paula McKay, Conor P. Kleweno, Julie Agel, Roman M. Natoli, Greg E. Gaski, Carrie L. Heincelman, Yohan Jang, Luke A. Lopas, Todd O. McKinley, Raveesh Daniel Richard, Anthony T. Sorkin, Walter Virkus, Lauren C. Hill, Robert A. Hymes, Michael Holzman, Farhanaz Panjshiri, Jeff E. Schulman, Lolita Ramsey, Jaslynn A.N. Cuff, Elliott R. Haut, Stephen J. Warner, Bryan A. Cotton, Keyla D. Guevara, Jeffrey A. Claridge, Heather A. Vallier, Mary A. Breslin, Daniel Connelly, Qasim M. Ghulam, Bryce E. Haac, Christopher T. Lebrun, Theodore T. Manson, Jason Nascone, Raymond A. Pensy, Andrew N. Pollak, Ugochukwu N. Udogwu, Cynthia Elaine Burke, Yasmin Degani, Genaro A. Deleon, Zachary D. Hannan, Kathleen M. Healey, Andrea L. Howe, Dimitrius P. Marinos, Phillip C. McKegg, Natasha S. McKibben, Nicolas H. Zingas, Andrew R. Evans, Brad M. Askam, Christina Boulton, John C. Weinlein, Patrick F. Bergin, Matthew E. Kutcher, John Morellato, Priyanka V. Nehete, Ugur Yener, Paul S. Whiting, Christopher Domes, Gabrielle R. Kuhn, Vamshi Gajari, Andres Fidel Moreno-Diaz, Elsa B. Rodriguez-Baron, Andres Rodriguez-Buitrago, Daniel J. Stinner, Karen M. Trochez, Peter Depalo, Leah C. Kennedy, Karin Lienhard, Ryan Martin, Stephanie C. Yee, Jordan Leonard, Hikmatullah Arif, Krista Brown, Lakye Lenee Deeter, Neil Sardesai, Abdulai T. Bangura, Haley K. Demyanovich, W. Andrew Eglseder, Jayesh Gupta, Marckenley Isaac, Alexandra Mulliken, M. J. Crisco, Stephanie N. Lueckel, Gregory A. Brown, Stephen Breazeale, Stephen N. Fisher, Jason R. Wild, Michael J. Beebe, Rajinder M. Khanna, Deborah Brauer, Robert H. Boyce

Research output: Contribution to journal › Article › peer-review

Abstract

Background:Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.Methods:This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales.Results:The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001).Conclusions:Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original language	English (US)
Pages (from-to)	590-599
Number of pages	10
Journal	Journal of Bone and Joint Surgery
Volume	106
Issue number	7
DOIs	https://doi.org/10.2106/JBJS.23.00824
State	Published - Apr 3 2024

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

Access to Document

10.2106/JBJS.23.00824

Cite this

O'Hara, N. N., Frey, K. P., Stein, D. M., Levy, J. F., Slobogean, G. P., Castillo, R., Firoozabadi, R., Karunakar, M. A., Gary, J. L., Obremskey, W. T., Seymour, R. B., Cuschieri, J., Mullins, C. D., O'Toole, R. V., Carlini, A. R., Fowler, B. E., Taylor, T. J., Wegener, S. T., Weston-Farber, E., ... Boyce, R. H. (2024). Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial. Journal of Bone and Joint Surgery, 106(7), 590-599. https://doi.org/10.2106/JBJS.23.00824

Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial. / O'Hara, Nathan N.; Frey, Katherine P.; Stein, Deborah M. et al.
In: Journal of Bone and Joint Surgery, Vol. 106, No. 7, 03.04.2024, p. 590-599.

Research output: Contribution to journal › Article › peer-review

O'Hara, NN, Frey, KP, Stein, DM, Levy, JF, Slobogean, GP, Castillo, R, Firoozabadi, R, Karunakar, MA, Gary, JL, Obremskey, WT, Seymour, RB, Cuschieri, J, Mullins, CD, O'Toole, RV, Carlini, AR, Fowler, BE, Taylor, TJ, Wegener, ST, Weston-Farber, E, Herndon, SC, Marvel, D, Jurkovich, GJ, Lee, C, Malhotra, AK, Riedel, MD, Decoster, TA, Vercellotti, GM, Wells, JL, Westrick, ER, Bosse, MJ, Christmas, AB, Cunningham, KW, Hsu, JR, Huynh, T, Jacobs, DG, Kempton, LB, Sims, SH, Churchill, C, Carroll, EA, Babcock, S, Miller, PR, Pilson, HT, Goodman, JB, Holden, MB, Weaver, MJ, Esposito, JG, Goldhaber, SZ, Heng, M, McGovern, MM, Velmahos, GC, Von Keudell, A, Rivera, JC, Gitajn, IL, Schneider, PS, Buckley, RE, Gallant, J, McKay, P, Kleweno, CP, Agel, J, Natoli, RM, Gaski, GE, Heincelman, CL, Jang, Y, Lopas, LA, McKinley, TO, Richard, RD, Sorkin, AT, Virkus, W, Hill, LC, Hymes, RA, Holzman, M, Panjshiri, F, Schulman, JE, Ramsey, L, Cuff, JAN, Haut, ER, Warner, SJ, Cotton, BA, Guevara, KD, Claridge, JA, Vallier, HA, Breslin, MA, Connelly, D, Ghulam, QM, Haac, BE, Lebrun, CT, Manson, TT, Nascone, J, Pensy, RA, Pollak, AN, Udogwu, UN, Burke, CE, Degani, Y, Deleon, GA, Hannan, ZD, Healey, KM, Howe, AL, Marinos, DP, McKegg, PC, McKibben, NS, Zingas, NH, Evans, AR, Askam, BM, Boulton, C, Weinlein, JC, Bergin, PF, Kutcher, ME, Morellato, J, Nehete, PV, Yener, U, Whiting, PS, Domes, C, Kuhn, GR, Gajari, V, Moreno-Diaz, AF, Rodriguez-Baron, EB, Rodriguez-Buitrago, A, Stinner, DJ, Trochez, KM, Depalo, P, Kennedy, LC, Lienhard, K, Martin, R, Yee, SC, Leonard, J, Arif, H, Brown, K, Deeter, LL, Sardesai, N, Bangura, AT, Demyanovich, HK, Eglseder, WA, Gupta, J, Isaac, M, Mulliken, A, Crisco, MJ, Lueckel, SN, Brown, GA, Breazeale, S, Fisher, SN, Wild, JR, Beebe, MJ, Khanna, RM, Brauer, D & Boyce, RH 2024, 'Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial', Journal of Bone and Joint Surgery, vol. 106, no. 7, pp. 590-599. https://doi.org/10.2106/JBJS.23.00824

@article{48c351d217ba4689a1e85b87adc8c5c8,

title = "Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial",

abstract = "Background:Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.Methods:This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales.Results:The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001).Conclusions:Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.",

author = "O'Hara, {Nathan N.} and Frey, {Katherine P.} and Stein, {Deborah M.} and Levy, {Joseph F.} and Slobogean, {Gerard P.} and Renan Castillo and Reza Firoozabadi and Karunakar, {Madhav A.} and Gary, {Joshua L.} and Obremskey, {William T.} and Seymour, {Rachel B.} and Joseph Cuschieri and Mullins, {C. Daniel} and O'Toole, {Robert V.} and Carlini, {Anthony R.} and Fowler, {Brianna E.} and Taylor, {Tara J.} and Wegener, {Stephen T.} and Elias Weston-Farber and Herndon, {Steven Craig} and Debra Marvel and Jurkovich, {Gregory J.} and Christopher Lee and Malhotra, {Ajai K.} and Riedel, {Matthew D.} and Decoster, {Thomas A.} and Vercellotti, {Gregory M.} and Wells, {Jeffrey L.} and Westrick, {Edward R.} and Bosse, {Michael J.} and Christmas, {A. Britton} and Cunningham, {Kyle William} and Hsu, {Joseph R.} and Toan Huynh and Jacobs, {David George} and Kempton, {Laurence B.} and Sims, {Stephen H.} and Christine Churchill and Carroll, {Eben A.} and Sharon Babcock and Miller, {Preston R.} and Pilson, {Holly T.} and Goodman, {James Brett} and Holden, {Martha B.} and Weaver, {Michael J.} and Esposito, {John G.} and Goldhaber, {Samuel Z.} and Marilyn Heng and McGovern, {Madeline M.} and Velmahos, {George C.} and {Von Keudell}, Arvind and Rivera, {Jessica C.} and Gitajn, {Ida Leah} and Schneider, {Prism S.} and Buckley, {Richard E.} and Jodi Gallant and Paula McKay and Kleweno, {Conor P.} and Julie Agel and Natoli, {Roman M.} and Gaski, {Greg E.} and Heincelman, {Carrie L.} and Yohan Jang and Lopas, {Luke A.} and McKinley, {Todd O.} and Richard, {Raveesh Daniel} and Sorkin, {Anthony T.} and Walter Virkus and Hill, {Lauren C.} and Hymes, {Robert A.} and Michael Holzman and Farhanaz Panjshiri and Schulman, {Jeff E.} and Lolita Ramsey and Cuff, {Jaslynn A.N.} and Haut, {Elliott R.} and Warner, {Stephen J.} and Cotton, {Bryan A.} and Guevara, {Keyla D.} and Claridge, {Jeffrey A.} and Vallier, {Heather A.} and Breslin, {Mary A.} and Daniel Connelly and Ghulam, {Qasim M.} and Haac, {Bryce E.} and Lebrun, {Christopher T.} and Manson, {Theodore T.} and Jason Nascone and Pensy, {Raymond A.} and Pollak, {Andrew N.} and Udogwu, {Ugochukwu N.} and Burke, {Cynthia Elaine} and Yasmin Degani and Deleon, {Genaro A.} and Hannan, {Zachary D.} and Healey, {Kathleen M.} and Howe, {Andrea L.} and Marinos, {Dimitrius P.} and McKegg, {Phillip C.} and McKibben, {Natasha S.} and Zingas, {Nicolas H.} and Evans, {Andrew R.} and Askam, {Brad M.} and Christina Boulton and Weinlein, {John C.} and Bergin, {Patrick F.} and Kutcher, {Matthew E.} and John Morellato and Nehete, {Priyanka V.} and Ugur Yener and Whiting, {Paul S.} and Christopher Domes and Kuhn, {Gabrielle R.} and Vamshi Gajari and Moreno-Diaz, {Andres Fidel} and Rodriguez-Baron, {Elsa B.} and Andres Rodriguez-Buitrago and Stinner, {Daniel J.} and Trochez, {Karen M.} and Peter Depalo and Kennedy, {Leah C.} and Karin Lienhard and Ryan Martin and Yee, {Stephanie C.} and Jordan Leonard and Hikmatullah Arif and Krista Brown and Deeter, {Lakye Lenee} and Neil Sardesai and Bangura, {Abdulai T.} and Demyanovich, {Haley K.} and Eglseder, {W. Andrew} and Jayesh Gupta and Marckenley Isaac and Alexandra Mulliken and Crisco, {M. J.} and Lueckel, {Stephanie N.} and Brown, {Gregory A.} and Stephen Breazeale and Fisher, {Stephen N.} and Wild, {Jason R.} and Beebe, {Michael J.} and Khanna, {Rajinder M.} and Deborah Brauer and Boyce, {Robert H.}",

year = "2024",

month = apr,

day = "3",

doi = "10.2106/JBJS.23.00824",

language = "English (US)",

volume = "106",

pages = "590--599",

journal = "Journal of Bone and Joint Surgery",

issn = "0021-9355",

publisher = "Journal of Bone and Joint Surgery Inc.",

number = "7",

}

TY - JOUR

T1 - Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs

T2 - A Secondary Analysis of a Randomized Clinical Trial

AU - O'Hara, Nathan N.

AU - Frey, Katherine P.

AU - Stein, Deborah M.

AU - Levy, Joseph F.

AU - Slobogean, Gerard P.

AU - Castillo, Renan

AU - Firoozabadi, Reza

AU - Karunakar, Madhav A.

AU - Gary, Joshua L.

AU - Obremskey, William T.

AU - Seymour, Rachel B.

AU - Cuschieri, Joseph

AU - Mullins, C. Daniel

AU - O'Toole, Robert V.

AU - Carlini, Anthony R.

AU - Fowler, Brianna E.

AU - Taylor, Tara J.

AU - Wegener, Stephen T.

AU - Weston-Farber, Elias

AU - Herndon, Steven Craig

AU - Marvel, Debra

AU - Jurkovich, Gregory J.

AU - Lee, Christopher

AU - Malhotra, Ajai K.

AU - Riedel, Matthew D.

AU - Decoster, Thomas A.

AU - Vercellotti, Gregory M.

AU - Wells, Jeffrey L.

AU - Westrick, Edward R.

AU - Bosse, Michael J.

AU - Christmas, A. Britton

AU - Cunningham, Kyle William

AU - Hsu, Joseph R.

AU - Huynh, Toan

AU - Jacobs, David George

AU - Kempton, Laurence B.

AU - Sims, Stephen H.

AU - Churchill, Christine

AU - Carroll, Eben A.

AU - Babcock, Sharon

AU - Miller, Preston R.

AU - Pilson, Holly T.

AU - Goodman, James Brett

AU - Holden, Martha B.

AU - Weaver, Michael J.

AU - Esposito, John G.

AU - Goldhaber, Samuel Z.

AU - Heng, Marilyn

AU - McGovern, Madeline M.

AU - Velmahos, George C.

AU - Von Keudell, Arvind

AU - Rivera, Jessica C.

AU - Gitajn, Ida Leah

AU - Schneider, Prism S.

AU - Buckley, Richard E.

AU - Gallant, Jodi

AU - McKay, Paula

AU - Kleweno, Conor P.

AU - Agel, Julie

AU - Natoli, Roman M.

AU - Gaski, Greg E.

AU - Heincelman, Carrie L.

AU - Jang, Yohan

AU - Lopas, Luke A.

AU - McKinley, Todd O.

AU - Richard, Raveesh Daniel

AU - Sorkin, Anthony T.

AU - Virkus, Walter

AU - Hill, Lauren C.

AU - Hymes, Robert A.

AU - Holzman, Michael

AU - Panjshiri, Farhanaz

AU - Schulman, Jeff E.

AU - Ramsey, Lolita

AU - Cuff, Jaslynn A.N.

AU - Haut, Elliott R.

AU - Warner, Stephen J.

AU - Cotton, Bryan A.

AU - Guevara, Keyla D.

AU - Claridge, Jeffrey A.

AU - Vallier, Heather A.

AU - Breslin, Mary A.

AU - Connelly, Daniel

AU - Ghulam, Qasim M.

AU - Haac, Bryce E.

AU - Lebrun, Christopher T.

AU - Manson, Theodore T.

AU - Nascone, Jason

AU - Pensy, Raymond A.

AU - Pollak, Andrew N.

AU - Udogwu, Ugochukwu N.

AU - Burke, Cynthia Elaine

AU - Degani, Yasmin

AU - Deleon, Genaro A.

AU - Hannan, Zachary D.

AU - Healey, Kathleen M.

AU - Howe, Andrea L.

AU - Marinos, Dimitrius P.

AU - McKegg, Phillip C.

AU - McKibben, Natasha S.

AU - Zingas, Nicolas H.

AU - Evans, Andrew R.

AU - Askam, Brad M.

AU - Boulton, Christina

AU - Weinlein, John C.

AU - Bergin, Patrick F.

AU - Kutcher, Matthew E.

AU - Morellato, John

AU - Nehete, Priyanka V.

AU - Yener, Ugur

AU - Whiting, Paul S.

AU - Domes, Christopher

AU - Kuhn, Gabrielle R.

AU - Gajari, Vamshi

AU - Moreno-Diaz, Andres Fidel

AU - Rodriguez-Baron, Elsa B.

AU - Rodriguez-Buitrago, Andres

AU - Stinner, Daniel J.

AU - Trochez, Karen M.

AU - Depalo, Peter

AU - Kennedy, Leah C.

AU - Lienhard, Karin

AU - Martin, Ryan

AU - Yee, Stephanie C.

AU - Leonard, Jordan

AU - Arif, Hikmatullah

AU - Brown, Krista

AU - Deeter, Lakye Lenee

AU - Sardesai, Neil

AU - Bangura, Abdulai T.

AU - Demyanovich, Haley K.

AU - Eglseder, W. Andrew

AU - Gupta, Jayesh

AU - Isaac, Marckenley

AU - Mulliken, Alexandra

AU - Crisco, M. J.

AU - Lueckel, Stephanie N.

AU - Brown, Gregory A.

AU - Breazeale, Stephen

AU - Fisher, Stephen N.

AU - Wild, Jason R.

AU - Beebe, Michael J.

AU - Khanna, Rajinder M.

AU - Brauer, Deborah

AU - Boyce, Robert H.

PY - 2024/4/3

Y1 - 2024/4/3

N2 - Background:Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.Methods:This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales.Results:The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001).Conclusions:Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

AB - Background:Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients' experiences with these medications, we compared patients' satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin.Methods:This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales.Results:The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p < 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p < 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95% CI: 0.12 to 0.18; p < 0.001).Conclusions:Use of aspirin substantially improved patients' satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

UR - http://www.scopus.com/inward/record.url?scp=85189854393&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85189854393&partnerID=8YFLogxK

U2 - 10.2106/JBJS.23.00824

DO - 10.2106/JBJS.23.00824

M3 - Article

C2 - 38381842

AN - SCOPUS:85189854393

SN - 0021-9355

VL - 106

SP - 590

EP - 599

JO - Journal of Bone and Joint Surgery

JF - Journal of Bone and Joint Surgery

IS - 7

ER -

Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

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