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January 8, 2024Frontiers in PharmacologyOpen Access

Comparison of efficacy and safety between aspirin and oral anticoagulants for venous thromboembolism prophylaxis after major orthopaedic surgery: a meta-analysis of randomized clinical trials

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Why the study?

Venous thromboembolism is a common complication after major orthopaedic surgery, and whether aspirin can be routinely used instead of oral anticoagulants remains controversial.

Does aspirin reduce any VTE event in patients undergoing major orthopaedic surgery compared to oral anticoagulants?

Population

5,088 participants undergoing THA, TKA, or hip fracture surgery across 12 RCTs

Comparison

Aspirin vs oral anticoagulants (rivaroxaban or warfarin)

Design

Meta-analysis of randomized clinical trials

Authors

XZXingyue ZhengUniversity of Electronic Science and Technology of ChinaNLNong LiGuangxi UniversityYSYujie SongNanchang University

Discussion

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Implication

Prefer oral anticoagulants over aspirin for VTE prophylaxis after major orthopedic surgery; meta-analysis confirms aspirin's reduced efficacy.

Key Points

  • To compare the efficacy and safety of aspirin versus oral anticoagulants for preventing venous thromboembolism after major orthopedic surgery.
  • Systematic review and meta-analysis of randomized clinical trials identified via PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov through July 20, 2023.
  • Included 12 trials encompassing 5,088 participants undergoing total hip arthroplasty, total knee arthroplasty, or hip fracture surgery assigned to aspirin (n=2,540), rivaroxaban (n=2,205), or warfarin (n=323).
  • Aspirin was less effective than oral anticoagulants in preventing any venous thromboembolism event (RR = 1.206, 95% CI 1.053–1.383), showing comparable efficacy to rivaroxaban but inferiority to warfarin.
  • Aspirin significantly reduced minor bleeding (RR = 0.685, 95% CI 0.552–0.850) and total bleeding events (RR = 0.726, 95% CI 0.590–0.892) compared with oral anticoagulants.
  • No significant differences were observed between aspirin and oral anticoagulants for major bleeding (RR = 0.952, 95% CI 0.499–1.815), all-cause mortality (RR = 1.208, 95% CI 0.459–3.177), or wound complications (RR = 0.618, 95% CI 0.333–1.145).

Structured PICO

Does aspirin reduce any VTE event in patients undergoing major orthopaedic surgery compared to oral anticoagulants?

P
Population
5,088 participants from 12 RCTs undergoing major orthopaedic surgery (total hip arthroplasty, total knee arthroplasty, or hip fracture surgery).
I
Intervention
Aspirin (various doses, e.g., 100 mg to 650 mg) for venous thromboembolism prophylaxis.
C
Comparator
Oral anticoagulants (rivaroxaban or warfarin) for venous thromboembolism prophylaxis.
O
Outcome
Any VTE event (including deep vein thrombosis (DVT) and pulmonary embolism (PE)).composite

Aspirin is less effective than oral anticoagulants for VTE prophylaxis after major orthopedic surgery, though it reduces the risk of minor bleeding.

Limitations

  • Studies in the warfarin group were all conducted before 2000

Cite This Study

Zheng et al. (2024) studied this question.

synapsesocial.com/papers/6a814b2a9fceb4fbd5e3e41chttps://doi.org/10.3389/fphar.2023.1326224
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of the Efficacy and Safety of Aspirin and Rivaroxaban Following Enoxaparin Treatment for Prevention of Venous Thromboembolism after Hip Fracture Surgery2019 · 20 citations
  2. 2European guidelines on perioperative venous thromboembolism prophylaxis2017 · 85 citations
  3. 3Venous Thromboembolism Prophylaxis After TKA: Aspirin, Warfarin, Enoxaparin, or Factor Xa Inhibitors?2017 · 146 citations
  4. 4The Benefit of Aspirin Chemoprophylaxis for Thromboembolism after Total Knee Arthroplasty2006 · 112 citations
  5. 5Trends of Venous Thromboembolism After Total Hip Arthroplasty in the United States: Analysis From 2011 to 20192023 · 25 citations