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Grand Rounds May 19, 2023: Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis After a Fracture (Robert O’Toole, MD) - Rethinking Clinical Trials

Robert O’Toole, MD Chief of Orthopaedics, R Adams Cowley Shock Trauma Center Head, Division of Orthopaedic Trauma Department of Orthopaedics Director, Clinical Research, Department of Orthopaedics University of Maryland School of Medicine

Pragmatic trials, orthopedic surgery, orthopedic trauma, Venous thromboembolism Luteinizing Hormone

Grand Rounds May 19, 2023: Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis After a Fracture (Robert O’Toole, MD) - Rethinking Clinical Trials

-Researchers decided to use a two-arm study with only Aspirin because of its low cost and its use in orthopedic arthroplasty.

-While people may be interested in specific subpopulations or outcomes, the confidence interval is not adjusted for multiple comparisons, so slicing the data could risk spurious findings.

-Clinician buy-in and understanding the social component of clinical work was essential to the pragmatic trial.

-The research team did not run into institutional barriers in the trial, likely because of the opportunity of Aspirin to be a much lower cost option if proven safe and effective.

Grand Rounds May 19, 2023: Aspirin or Low-Molecular-Weight Heparin for Thromboprophylaxis After a Fracture (Robert O’Toole, MD) - Rethinking Clinical Trials

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