[Translated article] Risk of venous thromboembolism in thromboprophylaxis between aspirin and low molecular weight heparins after total hip arthroplasty or total knee arthroplasty: Systematic review and meta-analysis

Introducción: El objetivo de este estudio fue evaluar la eficacia de la aspirina vs. las heparinas de bajo peso molecular (HBPM) para la profilaxis del tromboembolismo venoso (TEV), trombosis venosa profunda (TVP) y tromboembolismo pulmonar (TEP) en pacientes sometidos a artroplastia total de rodilla (ATR) y/o artroplastia total de cadera (ATC). Materiales y métodos: Revisión sistemática y metaanálisis. Se seleccionaron 16 estudios. Se analizaron el riesgo de TEV, TVP y TEP. También se analizó la mortalidad, riesgo de sangrado y complicaciones de la herida quirúrgica. Resultados: Doscientos cuarenta y ocho mil cuatrocientos sesenta y un (248.461) pacientes fueron incluidos; 176.406 pacientes con tromboprofilaxis con HBPM y 72.055 pacientes con tromboprofilaxis con aspirina. No hubo diferencias significativas en el riesgo del TEV (OR = 0,93; IC 95%: 0,69-1,26; p = 0,64), TVP (OR = 0,72; IC 95%: 0,43-1,20; p = 0,21) ni TEP (OR = 1,13; IC 95%: 0,86-1,49; p = 0,38) entre ambos grupos. Tampoco se hallaron diferencias significativas en la mortalidad (p = 0,30), sangrado (p = 0,22), ni complicaciones en la herida quirúrgica (p = 0,85) entre ambos grupos. Estos mismos hallazgos se encontraron en el subanálisis de solo ensayos clínicos aleatorizados (p > 0,05). Conclusiones: No se halló mayor riesgo de TEP, TVP, ni TEV entre los pacientes con tromboprofilaxis con aspirina vs. a los pacientes con tromboprofilaxis con HBPM. Tampoco se halló mayor mortalidad, mayor sangrado, ni mayores complicaciones en la herida quirúrgica entre los pacientes con tromboprofilaxis con aspirina vs. a los pacientes con tromboprofilaxis con HBPM. Introduction: The aim of this study was to evaluate the efficacy of aspirin versus low molecular weight heparins (LMWH) for the prophylaxis of venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing total knee arthroplasty (TKA) and/or total hip arthroplasty (THA). Materials and methods: Systematic review and meta-analysis. Sixteen studies were selected. The risk of VTE, DVT and PE were analyzed. Mortality, risk of bleeding and surgical wound complications was also analyzed. Results: 248,461 patients were included. 176,406 patients with thromboprophylaxis with LMWH and 72,055 patients with aspirin thromboprophylaxis. There were no significant differences in the risk of VTE (OR = 0.93; 95% CI: 0.69–1.26; P = .64), DVT (OR = 0.72; 95% CI: 0.43–1.20; P = .21) or PE (OR = 1.13; 95% CI: 0.86–1.49; P = .38) between both groups. No significant differences were found in mortality (P = .30), bleeding (P = .22), or complications in the surgical wound (P = .85) between both groups. These same findings were found in the sub-analysis of only randomized clinical trials (P > .05). Conclusions: No increased risk of PE, DVT, or VTE was found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis. There was also no greater mortality, greater bleeding, or greater complications in the surgical wound found among patients with aspirin thromboprophylaxis versus patients with LMWH thromboprophylaxis.