Aspirin showed comparable efficacy to enoxaparin in preventing pulmonary embolism (OR 1.14, 95% CI 0.66–1.95) but enoxaparin reduced deep vein thrombosis incidence more than aspirin (OR 0.78, 95% CI 0.64–0.96, p=0.02) after major orthopedic surgery.
Systematic Review (n=126,367)
Does aspirin prevent venous thromboembolism and reduce bleeding compared to enoxaparin in patients undergoing major orthopedic surgery?
In patients undergoing major orthopedic surgery, aspirin provides comparable efficacy to enoxaparin for preventing pulmonary embolism while significantly reducing the risk of major and minor bleeding.
Effect estimate: OR 1.14 for PE (95% CI 0.66–1.95), OR 0.78 for DVT (95% CI 0.64–0.96) in sensitivity analysis (95% CI PE 0.66–1.95; DVT 0.64–0.96)
p-value: PE p=0.67 primary, p=0.02 sensitivity; DVT p=0.67 primary, p=0.02 sensitivity
For patients undergoing major orthopedic surgery, aspirin is comparable to enoxaparin in preventing the primary efficacy outcomes of VTE (pulmonary embolism and deep vein thrombosis) but demonstrates a significant advantage in reducing the risk of minor bleeding. Aspirin represents an effective and safer prophylactic option, particularly for patients with higher bleeding risk profiles.
Haibier et al. (Mon,) conducted a systematic review in patients undergoing major orthopedic surgery (total hip arthroplasty, total knee arthroplasty, or hip fracture surgery) requiring thromboprophylaxis (n=126,367). aspirin vs. enoxaparin 30-40 mg subcutaneously once or twice daily was evaluated on incidence of venous thromboembolism (pulmonary embolism and deep vein thrombosis) (OR 1.14 for PE (95% CI 0.66–1.95), OR 0.78 for DVT (95% CI 0.64–0.96) in sensitivity analysis, 95% CI PE 0.66–1.95; DVT 0.64–0.96, p=PE p=0.67 primary, p=0.02 sensitivity; DVT p=0.67 primary, p=0.02 sensitivity). Aspirin showed comparable efficacy to enoxaparin in preventing pulmonary embolism (OR 1.14, 95% CI 0.66–1.95) but enoxaparin reduced deep vein thrombosis incidence more than aspirin (OR 0.78, 95% CI 0.64–0.96, p=0.02) after major orthopedic surgery.