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Meta-Analysis
. 2023 Oct 20;102(42):e35602.
doi: 10.1097/MD.0000000000035602.

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

Heng-Zhi Liu  1   2 , Jie Liang  1   2 , Ai-Xin Hu  1   2
Affiliations
Meta-Analysis

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

Heng-Zhi Liu et al. Medicine (Baltimore). .

Abstract

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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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Study flowchart.
Figure 2.
Figure 2.
Study quality assessments using the Cochrane Risk of Bias Manual.
Figure 3.
Figure 3.
Venous thromboembolism forest and funnel plots.
Figure 4.
Figure 4.
Proximal deep vein thrombosis/pulmonary embolism forest and funnel plots.
Figure 5.
Figure 5.
Bleeding event forest and funnel plots.
Figure 6.
Figure 6.
Wound complication forest and funnel plots.
Figure 7.
Figure 7.
Wound infection forest and funnel plots.
Figure 8.
Figure 8.
Transfusion event forest and funnel plots.
Figure 9.
Figure 9.
Death event forest and funnel plots.
Figure 10.
Figure 10.
Trauma or arthroplasty surgery choice on venous thromboembolism forest and funnel plots.
Figure 11.
Figure 11.
Combined with mechanical prevention of venous thromboembolism forest and funnel plots.
See this image and copyright information in PMC

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