Aspirin as a viable alternative to oral anticoagulants for VTE prevention after hip arthroplasty: a meta-analysis of randomized clinical trials

BACKGROUND: Hip arthroplasty is effective for advanced osteoarthritis but poses a high venous thromboembolism (VTE) risk without prophylaxis; this study aimed to evaluate whether aspirin is as effective and safe as oral anticoagulants (OACs) for VTE prevention in this setting. METHODS: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies up to June 01, 2024. The primary outcome was VTE incidence, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included bleeding and wound complications. RESULTS: Six RCTs involving patients undergoing hip arthroplasty were included. The pooled results demonstrated that aspirin had a comparable effect to OACs in preventing VTE (RR 0.90, 95% CI 0.63–1.29), with no significant differences observed in the incidence of DVT or PE. Additionally, no notable differences between the two groups in terms of bleeding risk or wound-related complications, although these safety outcomes were reported in fewer studies. Importantly, subgroup analyses across all pre-specified factors consistently supported the main findings, and no heterogeneity was observed in any outcome (I2 = 0% for all analyses). CONCLUSIONS: Based on existing RCT evidence, aspirin is as effective and safe as OACs for preventing VTE, DVT, and PE after hip arthroplasty, without increasing adverse events. The reliability of our conclusion is strengthened by the absence of heterogeneity in all our results, including those from subgroup analyses.