Some observational data suggest aspirin might afford effective VTE prophylaxis. A systematic review and meta-analysis of randomized clinical trials (RCTs) has recently examined the issue. RCTs assessing the effectiveness and safety of aspirin for VTE prophylaxis compared with other anticoagulants in adults undergoing THR and TKR were included. The primary outcome was any postoperative VTE (asymptomatic or symptomatic). Secondary outcomes were adverse events associated with therapy, including bleeding. 13 RCTs were included (6060 participants; 3466 [57.2%] women; mean age, 63.0 years). The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and pulmonary embolism (PE) (RR, 1.01; 95% CI, 0.68-1.48). Adverse events, including major bleeding, wound hematoma, and wound infection, was not significantly different in patients receiving aspirin vs other anticoagulants. Those treated with aspirin had a VTE risk not statistically significantly different from low-molecular-weight heparin (RR, 0.76; 95% CI, 0.37-1.56) or rivaroxaban (RR, 1.52; 95% CI, 0.56-4.12). The quality of the evidence ranged from low to high. Given the risks involved in the use of other anticoagulants, this issue seems destined for more searching examination. See the original paper here.
Aspirin for VTE prophylaxis after arthroplasty
Feb 17, 2020