A Systematic Review on the Use of Aspirin in the Prevention of Deep Vein Thrombosis in Major Elective Lower Limb Orthopedic Surgery: An Update from the Past 3 Years

Abstract

Introduction Currently there are no consensuses in the national guidance on thromboprophylaxis following major elective lower limb surgery. Emerging clinical evidence suggests that aspirin could be just as effective as anticoagulants with a lower cost. The aim of this study was to provide an update based on literature of the past 3 years for the use of aspirin as thromboprophylaxis after knee and hip arthroplasty. Materials and Methods MEDLINE/EMBASE search was performed with appropriate terms for original articles from 2014 to 2017. Results Eight articles were found. Five articles concluded that aspirin was an effective prophylactic. The collation of results on the deep vein thrombosis rate involved 43,012 patients who were prescribed aspirin, of which 283 (0.66%) suffered from symptomatic deep vein thromboses. Aspirin was noted for its good side effect profile and cost effectiveness. It was noted that anticoagulants had a higher rate of complications, including bleeding and wound-oozing. Conclusion Aspirin is an effective and safe prophylactic against deep vein thrombosis following major elective lower limb arthroplasty surgery.

Clinical, clinicopathologic, and gastrointestinal changes from administration of clopidogrel, prednisone, or combination in healthy dogs: A double‐blind randomized trial

“…However, bleeding risk varies dramatically among heparin and direct oral anticoagulants, potentially suggesting additional etiopathogenic factors. In people, anticoagulants are associated with similar or higher rates of adverse events than antiplatelet drugs . The incidence of gastrointestinal bleeding in dogs administered anticoagulants is unknown, and results of this study should not be extrapolated to their use.…”

Immune Factors in Deep Vein Thrombosis Initiation

“…Platelets are recruited to the venous wall shortly after blood flow restriction and play an important role in DVT as platelet depletion substantially reduces thrombosis [28] . A role of platelets in DVT is supported by the observations that an antiplatelet drug aspirin reduces DVT in mice (by preventing thromboxane A2 synthesis) [82] and VTE in patients undergoing orthopedic surgery 83 , 84 ; a condition frequently associated with compromised venous blood flow. Importantly, efficacy of venous thrombosis prophylaxis by aspirin is non-inferior to that of rivaroxaban, an anticoagulant widely used in clinical practice [85] , which confirms involvement of platelets in DVT pathogenesis.…”

Interplay between platelets and coagulation

“…Furthermore, platelets recruited to the venous wall may release high-mobility group box 1 (HMGB1) that can induce NETosis (formation of neutrophil extracellular traps), resulting in a scaffold for adhering platelets and red blood cells and promoting thrombin generation and fibrin deposition [190][191][192]. Not surprisingly, recent studies found that aspirin reduces DVT in mice and VTE in patients undergoing orthopedic surgery [193][194][195].…”