Aspirin as Thromboprophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

An, Vincent V.G.; Phan, Kevin; Levy, Yadin D.; Bruce, Warwick

doi:10.1016/j.arth.2016.04.004

Cited by 105 publications

(96 citation statements)

References 56 publications

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“…There was no significant difference between the incidence of symptomatic DVT or PE regarding lowdose or high-dose aspirin. The low prevalence of symptomatic VTE while using aspirin was comparable to previous studies [11,20,80], further supporting the efficacy of aspirin after TJA.…”

Section: Discussionsupporting

confidence: 81%

“…Additional highquality randomized controlled trials (RCT) are needed to further understand the effects of aspirin prophylaxis after TJA. However, the number of patients in an RCT required to reach adequate statistical power is very high due to the low incidence of symptomatic PE and DVT after TJA [11,20,80]. Also, because aspirin is considered an inexpensive drug compared to other anticoagulants, such RCTs may be precluded due to a lack of funding available.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, there is no systematic review published in the literature analyzing low-dose vs high-dose aspirin as well as investigating duration of aspirin for thromboprophylaxis after TJA. A prior systematic review published in 2016 investigated aspirin as a thromboprophylactic agent and found that aspirin alone and in multimodal approaches had a low incidence of VTE after hip and knee arthroplasty [20]. However, this study did not investigate the optimal dose and duration of aspirin, which are both critical factors for thromboprophylaxis.…”

mentioning

confidence: 94%

See 2 more Smart Citations

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

Azboy

Groff

Goswami

et al. 2020

The Journal of Arthroplasty

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 94%

See 1 more Smart Citation

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

Azboy

Groff

Goswami

et al. 2020

The Journal of Arthroplasty

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“…However, recently there have been more studies demonstrating the efficacy of aspirin for thromboprophylaxis. 15 Along with that, in 2012, the American College of Chest Physicians and American Association of Orthopaedic Surgery now both recommend aspirin as a chemoprophylactic drug for VTE. 3 Thus, with increasing support of the cheaper aspirin, the direct comparison to rivaroxaban, with all studies included in the meta-analysis from the past five years, is valuable.…”

Section: Discussionmentioning

confidence: 99%

A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: A meta-analysis

Kanagaratnam

Cao

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients are at an elevated risk of post-operative venous thromboembolism (VTE). Newer thromboprophylactic agents such as rivaroxaban are increasingly used and effective in preventing thromboembolic events but may worsen bleeding risk. Recent studies have suggested that the more cost-effective aspirin may also be effective in preventing VTE. This systematic review and meta-analysis aimed to compare the efficacy of aspirin against rivaroxaban for the prevention of VTE following TKA and THA. Methods: Electronic searches were performed using five databases from their date of inception to August 2018. Relevant studies were identified, with data extracted and meta-analyzed from the studies. Results: Five studies were included, which consisted of 2257 in the aspirin group and 2337 in the rivaroxaban group. There were no differences between aspirin and rivaroxaban for either VTE (p ¼ 0.48) or its components deep vein thrombosis (p ¼ 0.44) and pulmonary embolism (p ¼ 0.98). Also, there were no differences between groups for either major bleeding (p ¼ 0.17), any bleeding (p ¼ 0.62), readmissions (p ¼ 0.37) or wound complications (p ¼ 0.17). Conclusion: Aspirin was not significantly different to rivaroxaban for prevention of VTE or adverse events after TKA or THA. However, this study was limited by the significant heterogeneity of the included studies. More large randomized studies are needed to add to this body of evidence.

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“…Aspirin is an appealing alternative to anticoagulants because of its lower cost and ease of administration. However, the evidence base supporting the efficacy and safety of aspirin after arthroplasty is only weak to moderate in quality, with few randomized clinical trials addressing the topic in more contemporary patient populations [6–11]. In the absence of high quality clinical trial evidence, observational studies can provide important insights in trends in medication utilization and outcomes.…”

Section: Introductionmentioning

confidence: 99%

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

Chu

Maselli

Auerbach

et al. 2017

Thrombosis Research

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Background Recent guidelines include aspirin as an option to prevent venous thromboembolism (VTE) in selected patients undergoing hip or knee replacement surgery. However, the efficacy of aspirin after arthroplasty has not been well-defined, particularly in more contemporary patient populations. We compared rates of post-operative VTE between patients who received aspirin-only versus anticoagulants after hip or knee arthroplasty, using data from a large US-based administrative database. Materials and Methods We conducted a retrospective cohort study of 231,780 adults who underwent total knee arthroplasty and 110,621 who underwent total hip arthroplasty in 2009–2012 and who received pharmacologic VTE prophylaxis (aspirin or anticoagulant) within the first 7 days after surgery. We compared the risk of post-operative VTE between patients receiving aspirin-only vs. anticoagulants, controlling for clinical and hospital characteristics using multivariable logistic regression with propensity score adjustment. Results Aspirin-only prophylaxis was administered to 7.5% of patients after knee arthroplasty and 8.0% after hip arthroplasty. Post-operative VTE was diagnosed in 2,217 (0.96%) patients after knee arthroplasty and 454 (0.41%) after hip arthroplasty. Compared to anticoagulants, aspirin was not associated with a higher risk for post-operative VTE either after knee arthroplasty (adjusted odds ratio and 95% confidence interval [OR] 0.34 [0.24–0.48]) or hip arthroplasty (OR 0.82 [0.45–1.51]). Conclusions Aspirin was uncommonly administered as the sole prophylactic agent after hip or knee arthroplasty in this study. However, patients who received aspirin-only had similar rates of post-operative VTE compared to patients who received anticoagulants. Further research should focus on distinguishing which patients benefit more from anticoagulants versus aspirin after arthroplasty.

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Aspirin as Thromboprophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Cited by 105 publications

References 56 publications

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: A meta-analysis

The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty

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