VTE prophylaxis after THR and TKR: efficacy and safety of aspirin

Takeaway

• In patients who underwent total hip replacement (THR) and total knee replacement (TKR), no difference was observed in the risk for venous thromboembolism (VTE) between aspirin other anticoagulants used for VTE prophylaxis.

Why this matters

• Findings support the continuous use of aspirin in VTE prophylaxis post THR and TKR.

Study design

• Meta-analysis included 13 randomised controlled trials (RCTs; n=6060) identified after a search across electronic databases.
• Primary outcome: post-operative VTE (asymptomatic or symptomatic).
• Secondary outcomes: adverse events associated with anticoagulant therapy.
• Funding: NIHR Bristol Biomedical Research Centre.

Key results

• No significant difference was observed between aspirin and other anticoagulants group in the risk for:
  • VTE (relative risk [RR], 1.12; 95% CI, 0.78-1.62; I²=63%);
  • 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).
• No significant difference was observed between aspirin and low-molecular-weight heparin group in the risk for:
  • VTE (RR, 0.76; 95% CI, 0.37-1.56);
  • DVT (RR, 0.83; 95% CI, 0.42-1.63); and
  • PE (RR, 0.71; 95% CI, 0.19-2.61).
• Aspirin and rivaroxaban group did not significantly differ in the risk for:
  • VTE (RR, 1.52; 95% CI, 0.56-4.12) and
  • DVT (RR, 1.67; 95% CI, 0.53-5.26).
• When analysed THR and TKR separately, the risk for VTE, DVT and PE did not differ between aspirin and other anticoagulants group.
• No significant difference was observed in the risk for adverse events including major bleeding, wound haematoma and wound infection between both the groups.

Limitations

• Small sample size.