Key result
Aspirin prophylaxis was not significantly different from other anticoagulants in reducing the overall risk of venous thromboembolism in patients undergoing total hip or knee replacement (RR 0.81).
Why the study?
Guidelines do not recommend aspirin over other anticoagulants for VTE prophylaxis after TKR and THR because RCT meta-analyses lacked sufficient sample sizes for conclusive results.
Does aspirin prevent VTE in patients undergoing total hip or knee replacement compared to other anticoagulants?
Meta-Analysis (n=1,006,924)
Does aspirin prevent VTE in patients undergoing total hip or knee replacement compared to other anticoagulants?
Relative Risk: 0.81 (95% CI 0.55–1.2)
p-value: p=0.30
Aspirin may be an effective VTE prophylactic agent for patients undergoing total knee replacement, but is associated with higher VTE risk in total hip replacement compared to other anticoagulants.
Aspirin shows comparable VTE risk overall in NRS data, with benefit in TKR but harm in THR; leaves open guideline changes pending confirmatory RCTs.
Aspirin as an agent for thromboprophylaxis in patients with total knee replacement (TKR) and total hip replacement (THR) is gaining a lot of importance owing to its efficacy and safety in preventing venous thromboembolism (VTE) complications. The current guidelines do not recommend aspirin over other anticoagulants as the data from the meta-analysis of randomized controlled trails (RCTs) lacked a significant sample to draw conclusive results. The present study was aimed to carry out a systematic review and meta-analysis of nonrandomized studies (NRSs) to determine the effect of aspirin as prophylaxis for VTE. A complete electronic search was conducted at PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar for relevant articles published till March 2021. Any postsurgical VTE event (deep vein thrombosis and/or pulmonary embolism) is considered the primary outcome and adverse events as secondary outcomes. Both efficacy and safety outcomes were reported as pooled risk estimates with 95% confidence interval (CI) with a level of significance at P < 0.05. A total of 21 studies were identified for the analysis. The overall risk of occurrence of VTE among the patients taking aspirin was not significantly different from anticoagulants (risk ratio [RR]: 0.78, 95% CI: 0.52-1.15). Patients who underwent THR had a higher risk for VTE with aspirin (RR: 1.50, 95% CI: 1.35-1.61), whereas the patients who underwent TKR showed a lower risk of VTE with aspirin (RR: 0.80, 95% CI: 0.75-0.85). Meta-analysis of NRS advocates the role of aspirin as a prophylactic agent for VTE, especially for patients who are in need for TKR. Further RCTs are required to reestablish the role of aspirin, especially in patients undergoing THR.
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Maddukuri et al. (2024) conducted a meta-analysis in Total hip or knee replacement (n=1,006,924). Aspirin vs. Anticoagulants was evaluated on Any postsurgical VTE event (DVT and/or PE) (RR 0.81, 95% CI 0.55-1.20, p=0.30). Aspirin prophylaxis was not significantly different from other anticoagulants in reducing the overall risk of venous thromboembolism in patients undergoing total hip or knee replacement (RR 0.81).
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