Key result
Aspirin shows no benefit over anticoagulation for preventing VTE after orthopedic trauma or surgery.
Why the study?
The risk of venous thromboembolism following orthopedic trauma and surgery is high, but consensus has not yet been reached for the best pharmacologic prevention and guideline recommendations vary across expert societies.
Does aspirin prevent venous thromboembolism events as effectively as anticoagulation in patients following orthopedic trauma or surgery?
Meta-Analysis (n=17,963)
Does aspirin prevent venous thromboembolism events as effectively as anticoagulation in patients following orthopedic trauma or surgery?
Relative Risk: 1.03 (95% CI 0.71–1.48)
p-value: p=0.88
Aspirin appears to be as effective and safe as anticoagulation for VTE prophylaxis following orthopedic trauma or surgery.
Supports aspirin as a viable alternative to anticoagulation for post-orthopedic VTE prophylaxis; extends pooled RCT evidence to inform guidelines.
Background The risk for venous thromboembolism (VTE) following orthopedic trauma and surgery is high. When preventive measures are not used, the odds of DVT can reach 60% within 90 days from surgery and 1.5% for fatal pulmonary embolism. Until now, consensus is not yet reached for the best pharmacologic prevention given the clinical situation. Guidelines on VTE prophylaxis vary across expert societies. Objective To compare the clinical effectiveness and safety between aspirin and anticoagulation in preventing venous thromboembolism (VTE) following an orthopedic trauma or surgery Study Selection Only randomized controlled trials (RCT) comparing aspirin and any anticoagulants as VTE prophylaxis following an orthopedic trauma or surgery were selected for review. Methods Pubmed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) reporting clinical outcomes of aspirin versus any anticoagulants for VTE prevention. Primary endpoint was composite of venous thromboembolism (VTE) events. Secondary endpoints were mortality, bleeding events, and wound complications. Results Eleven RCTs with 17,963 patients were included in the analysis. Patients receiving aspirin as VTE prophylaxis have no significant difference in terms of reducing venous thromboembolism (VTE) events (RR 1.03; 95% CI, 0.71-1.48; p = 0.88), mortality (RR 1.01; 95% CI, 0.68-1.49; p = 0.97), bleeding events (RR 0.97; 95% CI, 0.80-1.05; p = 0.38), and wound complications (RR 0.76; 95% CI, 0.50-1.16; p = 0.21), as compared to anticoagulation after orthopedic trauma or surgery. Conclusion There are no significant differences between aspirin and anticoagulation in terms of reducing venous thromboembolism events, mortality, bleeding events, and wound complications following orthopedic trauma or surgery.
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Dakay et al. (2023) conducted a meta-analysis in Venous thromboembolism following orthopedic trauma and surgery (n=17,963). Aspirin vs. Anticoagulation was evaluated on Composite of venous thromboembolism (VTE) events (RR 1.03, 95% CI 0.71-1.48, p=0.88). Aspirin showed no significant difference compared to anticoagulation in reducing venous thromboembolism events following orthopedic trauma or surgery (RR 1.03; 95% CI 0.71-1.48; p=0.88).
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