From the Guidelines
For a patient with a contusion on the medial aspect of the knee with progressive swelling extending to the ankle who is taking daily aspirin, I recommend temporarily discontinuing the aspirin and implementing the RICE protocol (Rest, Ice, Compression, Elevation) for 48-72 hours. The patient should rest the affected leg, apply ice packs for 15-20 minutes every 2-3 hours, use a compression bandage from mid-foot to mid-thigh, and elevate the leg above heart level when possible. After the acute phase, gentle range-of-motion exercises can begin. Over-the-counter acetaminophen (Tylenol) at 500-1000mg every 6 hours as needed (not exceeding 4000mg daily) can be used for pain management instead of aspirin, as suggested by the American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee 1. The patient should be evaluated for possible deep vein thrombosis given the progressive swelling, particularly if accompanied by warmth, redness, or calf pain. Aspirin discontinuation is recommended because it inhibits platelet aggregation and may worsen bleeding and bruising associated with the contusion, as noted in the 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease 1. The patient should consult their physician before stopping aspirin if it was prescribed for cardiovascular protection. If symptoms worsen or don't improve within 3-5 days, medical evaluation is necessary to rule out more serious injuries like ligament damage or fracture. Key considerations include:
- Temporarily stopping aspirin to minimize bleeding risk
- Implementing RICE protocol for initial management
- Using acetaminophen for pain management
- Monitoring for deep vein thrombosis
- Consulting a physician before stopping aspirin for cardiovascular protection.
From the Research
Patient Presentation
The patient presents with a contusion on the medial aspect of her knee, accompanied by leg pain and swelling that has progressed to her ankle. She is able to bear weight and is currently taking daily Aspirin (acetylsalicylic acid).
Treatment Considerations
- The patient's current medication, Aspirin, may have an impact on her treatment options. Studies have shown that Aspirin can be effective in preventing venous thromboembolism (VTE) after total knee arthroplasty 2, 3.
- Given the patient's ability to bear weight, treatment should focus on managing pain and swelling, as well as preventing further complications such as VTE.
- The use of ice therapy has been shown to be effective in reducing inflammation and pain after acute soft tissue injury 4.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may also be considered to reduce swelling and relieve pain, but their effects may not be seen for several days in severe cases, and gastrointestinal side effects are not uncommon 5.
Potential Treatment Options
- Continue Aspirin therapy to prevent VTE, as it has been shown to be effective in this regard 2, 3.
- Apply ice therapy to reduce inflammation and pain, using repeated applications of 10 minutes to be most effective 4.
- Consider the use of NSAIDs or other analgesics to relieve pain, but weigh the potential benefits against the risks of gastrointestinal side effects 5.
- Monitor the patient's condition closely for signs of VTE or other complications, and adjust treatment as necessary.