Aspirin versus low-molecular-weight heparin for thromboprophylaxis after orthopaedic surgery: a systematic review and meta-analysis

Abstract

The article aimed to compare the efficiency and safety of aspirin with low-molecular-weight heparin (LMWH) for thromboprophylaxis in orthopaedic surgery patients. According to the inclusion and exclusion criteria, PubMed, Embase and Cochrane Library database were searched for studies comparing aspirin and LMWH in venous thromboembolism (VTE) prophylaxis until 25 April 2023. The outcome measures included deep venous thrombosis(DVT)/Pulmonary embolism(PE) events, major bleeding events, wound complications, wound infection and death. Six studies met the requirements of our meta-analysis, including 12 470 patients in the aspirin group and 10 857 patients in the LMWH group. The meta-analysis showed that results showed that LMWH was superior to aspirin in preventing VTE events (odds ratio (OR) 1.44, 95% CI 1.24-1.68, P < 0.00001), whereas there was no significant difference between them in bleeding events (OR 0.95, 95% CI 0.86-1.05, P = 0.33), wound complication (OR 0.58, 95% CI 0.28-1.17, P = 0.13), wound infection (OR 1.12, 95% CI 0.86-1.47, P = 0.39) and mortality (OR 1.04, 95% CI 0.70-1.55, P = 0.83). In addition, subgroup analysis showed that compared with aspirin, LMWH was more likely to reduce the incidence of DVT events in orthopaedic surgery patients (OR 1.59, 95% CI 1.33-1.91, P < 0.00001), whereas there was no advantage in reducing the incidence of PE events (OR 1.22, 95% CI 0.62-2.40, P = 0.56). Despite the similar safety profiles, this meta-analysis showed that LMWH was significantly superior to aspirin in thromboprophylaxis after orthopaedic surgery. LMWH was still the first-line drug for thrombosis prevention in patients who underwent major orthopaedic surgeries.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses flow chart for article selection.

Fig. 2

(a) Forest plot of the result comparing aspirin versus low-molecular-weight heparin for venous thromboembolism events. (b) Forest plot of the result comparing aspirin versus low-molecular-weight heparin (LMWH) for DVT events. (c) Forest plot of the result comparing aspirin versus LMWH for PE events. CI, confidence intervals; DVT, deep venous thrombosis; Fixed, a Fixed effects model; M–H, Mantel–Haenszel test; PE, Pulmonary embolism; Random, a random effects model.

Fig. 3

Forest plot of the result comparing aspirin versus low-molecular-weight heparin for major bleeding events. CI, confidence intervals; Fixed, a Fixed effects model; M–H, Mantel–Haenszel test.

Fig. 4

Forest plot of the result comparing aspirin versus low-molecular-weight heparin for wound complications. CI, confidence intervals; Fixed, a Fixed effects model; M–H, Mantel–Haenszel test.

Fig. 5

Forest plot of the result comparing aspirin versus low-molecular-weight heparin for wound infection. CI, confidence intervals; M–H, Mantel–Haenszel test; Random, a random effects model.

Fig. 6

Forest plot of the result comparing aspirin versus low-molecular-weight heparin for death. CI, confidence intervals; Fixed, a Fixed effects model; M–H, Mantel–Haenszel test.

Fig. 7

Quality assessment of the included studies.