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Altered mental status
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Gastrointestinal ulcers
Hematoma formation
Infection of hardware
Thrombocytopenia
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This patient with no cardiac risk factors who underwent total knee arthroplasty was most likely started on aspirin for deep venous thrombosis prophylaxis post-operatively. The most likely adverse effect of low-dose aspirin is the development of gastrointestinal ulcers. Aspirin is a non-steroidal anti-inflammatory drug that is commonly used in low doses after surgery because it inhibits platelet aggregation and decreases the risk of deep venous thrombosis. Aspirin toxicity can be divided into toxicities that occur after acute overdose and those that occur with chronic use. Chronic toxicity is more relevant for chronic prophylaxis and includes interstitial nephritis, gastric ulcers and bleeding, pill-induced esophagitis, and decreased uric acid excretion in patients with gout. Fukushi et al. studied the effects of gastroduodenal ulcer bleeding in patients on low-dose aspirin therapy. They found that combining aspirin with other non-steroidal anti-inflammatory drugs or antithrombotic drugs increased the risk of bleeding. Incorrect Answers: Answer 1: Altered mental status can occur with acute aspirin overdose; however, chronic low dose aspirin usage would not result in acute toxicity. Patients who acutely overdose on aspirin by contrast may experience tinnitus, vertigo, nausea, altered mental status, metabolic acidosis, and respiratory alkalosis. Answer 3: Hematoma formation can occur with the use of anticoagulants such as warfarin; however, in this patient with no cardiac risk factors, aspirin would be used for deep venous thrombosis prophylaxis rather than anticoagulants. Answer 4: Infection of hardware can occur due to contamination of the implant during surgery; however, this is most associated with failure to provide peri-operative antibiotic prophylaxis rather than deep venous thrombosis prophylaxis. Answer 5: Thrombocytopenia is a known side effect of heparin in patients who develop antibodies against this anticoagulant; however, heparin is not used for deep venous thrombosis prophylaxis in patients with no cardiac risk factors after elective joint surgery. Bullet Summary: Aspirin can cause gastrointestinal ulcers and bleeding, even when taken for low-dose prophylaxis.
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