Published 1/1/2013

Second Look-Clinical News and Views

FDA approves tofacitinib for RA
The U.S. Food and Drug Administration (FDA) approved the marketing of tofacitinib—a drug designed to treat adults with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to, or who are intolerant of, methotrexate. The FDA is requiring a postmarketing study that will evaluate two doses of tofacitinib and include a group of patients on another approved treatment to serve as a comparison.

Aspirin as thromboembolic prophylaxis for TJR patients
Information presented at the annual meeting of the American Association of Hip and Knee Surgeons suggests that aspirin may be a viable alternative to warfarin for healthy total joint replacement (TJR) patients. Among patients who underwent joint replacement surgery at a single center between 2000 and 2011—1,824 of whom received prophylactic aspirin prior to surgery, and 24,567 of whom received prophylactic warfarin—patients in the aspirin group had a significantly lower overall rate of pulmonary embolism than those in the warfarin group. In addition, rates of hematoma, wound problems, acute infection, and 90-day mortality were lower in the aspirin group.

Study: THA and stroke risk
According to data from a Danish study published online in Stroke, patients who undergo total hip arthroplasty (THA) may be at increased risk of stroke during the first 2 weeks after surgery. The nationwide cohort study of patients in a Danish registry (1998–2007) involved 66,583 patients who underwent primary THA matched by age, sex, and region to three referent patients who did not undergo THA or TKA. THA patients had a 4.7-fold increased risk of ischemic stroke and a 4.4-fold increased risk of hemorrhagic stroke within 2 weeks of surgery, compared to controls. The risk for ischemic stroke remained elevated during the first 6 postoperative weeks; for hemorrhagic stroke, the risk remained elevated for the first 12 postoperative weeks.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)