Aspirin clinically effective, safe for VTE prophylaxis after THR, TKR vs other anticoagulants
Aspirin was not statistically significantly different from other anticoagulants when used for venous thromboembolism prophylaxis after either total hip replacement or total knee replacement with regard to its clinical effectiveness and safety profile, according to published results.
Through a systematic review and meta-analysis performed of randomized clinical trials that evaluated the effectiveness and safety of aspirin for venous thromboembolism prophylaxis for patients who underwent either THR or TKR, researchers identified 437 articles, of which 13 were included. Investigators used the Cochrane Collaboration risk of bias tool and screened and extracted data. The grading of recommendations assessment, development and evaluation approach was used to evaluate the quality of evidence. Any postoperative VTE, either asymptomatic or symptomatic, was the primary outcome. Other outcomes included adverse events correlated with therapy such as bleeding. Random effects models were used to aggregate study-specific relative risks.
Results showed that after THR and TKR, the relative risk (RR) of VTE was 1.12 for aspirin vs. other anticoagulants. Investigators noted similar outcomes for deep vein thrombosis (DVT; RR 1.04) and pulmonary embolism (PE; RR 1.01). There was no statistically significant difference in patients who received aspiring compared with other anticoagulants with regard to the risk of adverse events, such as major bleeding, wound hematoma and wound infection. Between the use of aspiring and other anticoagulants, there was no statistically significant difference in the risk of VTE, DVT and PE when THR and TKR were analyzed separately. There was no statistically significant difference in the VTE risk between aspiring, low-molecular-weight heparin and rivaroxaban. Investigators noted there was a low to high range with regard to the quality of evidence. – by Monica Jaramillo
Disclosures: Matharu reports he receives personal fees from Leigh Day for medicolegal work. Please see the study for all other authors’ relevant financial disclosures.