Aspirin thromboprophylaxis in joint replacement surgery

Sharda, Anish V.; Fatovic, Kathy; Bauer, Kenneth A.

doi:10.1002/rth2.12649

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…22 30 More recent studies suggest that low-dose aspirin was inferior to LMWH, and was associated with a higher risk of VTE than previously reported. 102 116 124 125 In the current network meta-analysis, we found that studies using aspirin as a whole reported higher rates of VTE relative to LMWH. As such, the choice of aspirin as a viable alternative to LMWH should be revisited.…”

Section: Discussionmentioning

confidence: 85%

Pharmacotherapy for Venous Thromboprophylaxis following Total Hip or Knee Arthroplasty: A Systematic Review and Network Meta-analysis

Yong,

Ling,

Ramanathan

et al. 2024

Semin Thromb Hemost

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The optimal pharmacological prophylaxis for venous thromboembolism (VTE) after hip or knee arthroplasty is uncertain. We conducted a systematic review and network meta-analysis to compare the efficacy and safety of various medications. We searched multiple databases for randomized clinical trials (RCTs) comparing medications (including factor Xa inhibitors, factor IIa inhibitor, warfarin, unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], aspirin, pentasaccharide) for VTE prophylaxis post-arthroplasty. Outcomes included any postoperative VTE identified with screening, major bleeding, and death. We used LMWH as the main comparator for analysis and performed trial sequential analysis (TSA) for each pairwise comparison. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessments, Developments and Evaluations). We analyzed 70 RCTs (55,841 participants). Factor Xa inhibitors decreased postoperative VTE significantly compared with LMWH (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.44–0.68, high certainty). Pentasaccharides probably reduce VTE (OR: 0.61, 95% CI: 0.36–1.02, moderate certainty), while the factor IIa inhibitor dabigatran may reduce VTE (OR: 0.75, 95% CI: 0.40–1.42, low certainty). UFH probably increases VTE compared with LMWH (OR: 1.31, 95% CI: 0.91–1.89, moderate certainty), and other agents like warfarin, aspirin, placebo, and usual care without thromboprophylaxis increase VTE (high certainty). Factor Xa inhibitors may not significantly affect major bleeding compared with LMWH (OR: 1.06, 95% CI: 0.81–1.39, low certainty). No medications had a notable effect on mortality compared with LMWH (very low certainty). TSA suggests sufficient evidence for the benefit of factor Xa inhibitors over LMWH for VTE prevention. Compared with LMWH and aspirin, factor Xa inhibitors are associated with reduced VTE after hip or knee arthroplasty, without an increase in bleeding and likely no impact on mortality.

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Section: Discussionmentioning

confidence: 85%