Aspirina versus rivaroxabana na prevenção do tromboembolismo venoso após artroplastia total do joelho: Um ensaio clínico randomizado, controlado e duplo-cego

Hongnaparak, Theerawit; Janejaturanon, Jiranuwat; Iamthanaporn, Khanin; Tanutit, Pramot; Yuenyongviwat, Varah

doi:10.1055/s-0041-1735941

Cited by 5 publications

(9 citation statements)

References 17 publications

(53 reference statements)

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“…The 16 selected studies [10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] assessed DVT in major orthopedic surgery: the VTE incidence was more high in the aspirin group when compared with other anticoagulants (RR = 1.45, 95% CI = 1.18-1.77, P = .0004). As high heterogeneity (P = .002, I 2 = 59%) was identified (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…3). Proximal DVT was defined as at least 1 DVT in the iliac, femoral, or popliteal vein in any one lower extremity: 13 studies [10,11,[14][15][16][17]19,[21][22][23]25,26,28] assessed proximal DVT and/or PE incidence was more high in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02-1.39, P = .03). As low heterogeneity (P = .29, I 2 = 15%) was identified (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Bleeding events, including significant bleeding concomitant with reduced hemoglobin levels (>20 g/L), transfusion ≥ 2 units, organ bleeding, and abnormal bleeding at the surgical site, were included in 15 studies [10,11,[14][15][16][17][18][19][21][22][23][24][25][26][27] and showed no significant difference in the aspirin group when compared with other anticoagulants (RR = 0.83, 95% CI = 0.63-1.10, P = .20). As high heterogeneity (P = .03, I 2 = 48%) was identified (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Subgroup analyses also showed that aspirin was inferior to other anticoagulants in terms of VTE incidence in selecting the surgical approach for major orthopedic surgery (RR = 1.45, 95% CI = 1.18-1.77, P = .0004), with high heterogeneity (P = .002, I 2 = 59%). Four trauma groups 11,17,18,23 were included to assess the prevention of VTE in orthopedic trauma surgery, and the incidence of VTE in the aspirin group was inferior to that of other anticoagulants (RR = 1.39, 95% CI = 1.14-1.74, P = .004), P = .27, I 2 = 23%), and 12 post-THA/TKA 10,[14][15][16]19,21,22,[24][25][26][27] assessments were included for prevention of VTE, and the incidence of VTE in the aspirin group was inferior to that of other anticoagulants (RR = 1.39, 95% CI = 1.02-1.90, P = .04) with high heterogeneity (P = .0007, I 2 = 67%) (Fig. 10).…”

Section: Resultsmentioning

confidence: 99%

“…Wound complications, including wound hematoma, persistent wound exudate, and erythema, were included in 6 studies [ 11 , 19 , 20 , 24 , 27 , 28 ] and showed no significant differences in the aspirin group when compared with other anticoagulants (RR = 0.45, 95% CI = 0.20–1.04, P = .06). As low heterogeneity ( P = .24, I 2 = 28%) was identified (Fig.…”

Section: Resultsmentioning

confidence: 99%

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The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials

Liu,

Liang,

2023

Medicine

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Background: Major orthopedic surgery, including hip and knee replacement and lower extremity trauma fractures surgery, is associated with a high risk of venous thromboembolism (VTE), especially proximal deep vein thrombosis (DVT), and pulmonary embolism (PE), and is linked with high morbidity and mortality rates. Chemical anticoagulation is routinely used to prevent VTE, with previous meta-analyses reporting on the efficacy and safety of aspirin and other anticoagulants, however, opinions are divided. In the past 2 years, several large randomized controlled trials have been published, therefore, we reanalyzed aspirin efficacy and safety when compared with other anticoagulants in preventing VTE in major orthopedic surgery. Methods: Using PubMed, The Cochrane Library, Embase, and Web of Science databases, we conducted a RCT search in August 2023. The main outcomes included VTE, proximal DVT or PE. Additional outcomes included bleeding events, wound complications, wound infections, blood transfusions, and death events. Results: In total, 17 eligible articles, involving 29,522 patients (15,253 aspirin vs 14,269 other anticoagulant cases), were included. Primary outcomes showed that VTE incidence was more high in the aspirin group when compared with other anticoagulants (risk ratio [RR] = 1.45, 95% confidence interval [CI] = 1.18–1.77, P = .0004) and proximal in the aspirin group the DVT and/or PE incidence was significantly higher in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02–1.39, P = .03). No significant secondary outcome differences were identified in the aspirin group when compared with other anticoagulants (bleeding events [RR] = 0.83, 95% CI = 0.63–1.10, P = .20); wound complications (RR = 0.45, 95% CI = 0.20–1.04, P = .06); wound infection (RR = 1.08, 95% CI = 0.85–1.38, P = .53); blood transfusion events (RR = 1.00, 95% CI = 0.84–1.19, P = 1.00) and death events (RR = 1.11, 95% CI = 0.78–1.57, P = .55). Conclusions: Our updated meta-analysis showed that aspirin was inferior to when compared with other anticoagulants in VTE-related orthopedic major surgery, including proximal DVT and/or PE, and was more likely to form VTE. No differences between groups were identified for bleeding, wound complications, wound infections, transfusion, or death events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials

Liu,

Liang,

2023

Medicine

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Comparative efficacy of aspirin versus direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty: A systematic review and meta‐analysis of randomised controlled trials

Syed,

Amin,

Benjamin

et al. 2024

J. exp. orthop.

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IntroductionVenous thromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary embolisms (PE), are common after total knee (TKA) and hip arthroplasty (THA). Recent studies suggest that aspirin effectively prevents VTE following major orthopaedic surgery. This meta‐analysis compares randomised controlled trials (RCTs) evaluating aspirin versus direct oral anticoagulants (DOACs) for VTE prevention after primary THA and TKA.MethodsWe included RCTs from 2017 to 2023 that looked at aspirin versus DOACs for VTE prophylaxis in primary THA and TKA. A search strategy was conducted which used Boolean operators and MESH terms. Primary outcomes included VTE rates, symptomatic, asymptomatic DVT and PE. Secondary outcomes were mortality and bleeding complications. Statistical analysis was performed using REVMAN software. An odds ratio with a 95% confidence interval was generated for the pooled studies. Heterogeneity was assessed using the I2 variable, and publication bias was evaluated with a funnel plot.ResultsSeven RCTs with 3967 patients were included for analysis. Rivaroxaban 10 mg OD was compared to varying doses of aspirin (81–300 mg). There were no significant differences between the groups in the incidence of VTE (OR: 1.21, 95% CI: 0.72–2.01), PE (OR: 1.01, 95% CI: 0.39–2.61), asymptomatic DVT (OR: 1.39, 95% CI: 0.64–3.00), suspected DVT (OR: 1.13, 95% CI: 0.49–2.61) and major bleeding (OR: 0.84, 95% CI: 0.55–1.27).DiscussionAspirin is as effective as rivaroxaban for primary thromboprophylaxis post‐THA and TKA, without increased incidence of complications. Further research is needed to determine the optimal dosing regimen of aspirin and its long‐term efficacy in preventing VTE.Level of EvidenceLevel I.

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Efficacy and safety of aspirin in venous thromboembolism prevention after total hip arthroplasty, total knee arthroplasty or fracture

Jiang,

Yan,

Huang

et al. 2024

Vasa

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Summary: Background: This study aims to analyse the efficacy and safety of aspirin in the prevention of venous thromboembolism (VTE) for patients undergoing total hip arthroplasty (THA), total knee arthroplasty (TKA) or fracture. Patients and methods: Two independent investigators searched PubMed, Embase, Cochrane and ClinicalTrials.gov from January 2000 to June 2023 to retrieve randomized control trials (RCTs) about aspirin in VTE prevention after arthroplasty or fracture. Then, the relative risk (RR) was utilized to evaluate its efficiency and safety. Results: A total of 16 RCTs with 27,864 patients were included. There was no statistical difference in the incidence of deep-vein thrombosis (RR: 1.31, p = 0.100), pulmonary embolism (RR:1.05, p = 0.850), VTE (RR:1.28, p = 0.290), major bleeding (RR:0.96, p = 0.900), and death (RR:1.01, p = 0.960) between the aspirin group and the anticoagulants group. Subgroup analysis showed that a relatively higher incidence of deep-vein thrombosis in patients undergoing TKA (RR:1.49, p = 0.030), fracture (RR:1.48, p = 0.001), patients receiving 81 mg aspirin twice daily (RR:1.48, p = 0.001) and patients from North America (RR:1.57, p<0.001) when comparing aspirin with anticoagulants. Meanwhile, the incidence of VTE was higher in patients receiving 100 mg aspirin once daily (RR:1.82, p<0.001) compared with anticoagulants. Additionally, the incidence of all bleeding (RR:2.00, p = 0.030) was higher in patients receiving aspirin in Asia compared with anticoagulants. Conclusions: In terms of clinical effectiveness and safety, aspirin (antiplatelet agent) was generally not inferior to anticoagulants in the prevention of VTE after THA, TKA, or fracture. Notably, the clinical effectiveness of aspirin was affected by different surgical types, the doses of aspirin and races.

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Aspirina versus rivaroxabana na prevenção do tromboembolismo venoso após artroplastia total do joelho: Um ensaio clínico randomizado, controlado e duplo-cego

Cited by 5 publications

References 17 publications

The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials

The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials

Comparative efficacy of aspirin versus direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty: A systematic review and meta‐analysis of randomised controlled trials

Efficacy and safety of aspirin in venous thromboembolism prevention after total hip arthroplasty, total knee arthroplasty or fracture

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