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Meta-Analysis
. 2025 May 17;15(1):17213.
doi: 10.1038/s41598-025-02171-z.

Aspirin for the extended prevention of venous thromboembolism: a meta-analysis and trial sequential analysis

Michele Carron  1   2 , Enrico Tamburini  3 , Tommaso Pettenuzzo  3 , Francesco Zarantonello  3 , Elena Campello  4 , Paolo Navalesi  5   3 , Paolo Simioni  4
Affiliations
Meta-Analysis

Aspirin for the extended prevention of venous thromboembolism: a meta-analysis and trial sequential analysis

Michele Carron et al. Sci Rep. .

Abstract

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication following surgery and in high-risk scenarios. Aspirin may provide an alternative for extended VTE prophylaxis, but its risk-benefit profile remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials, following PRISMA guidelines, to evaluate aspirin's efficacy and safety for extended VTE prevention. Subgroup analyses included primary and secondary prevention, provoked and unprovoked VTE, and low-dose aspirin. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model, and trial sequential analysis was used to assess the robustness of the evidence. Five trials including 68,554 patients were analyzed. Aspirin (100-160 mg) significantly reduced the risk of VTE, DVT, PE, and VTE-related mortality compared to placebo, particularly in primary prevention and provoked VTE cases. No benefit was observed in secondary prevention, while some benefit emerged for unprovoked VTE, limited to overall VTE risk. Low-dose aspirin (100 mg) did not significantly reduce the incidence of VTE, DVT, or PE. Aspirin increased the risks of overall and major bleeding but did not elevate blood transfusion requirements or major cardiovascular events. These findings suggest that prolonged aspirin therapy may have a role in extended VTE prevention, particularly in patients at risk for provoked VTE. However, careful patient selection remains crucial, and further studies are needed to refine its indications and optimal dosing strategy.

Keywords: Aspirin; Deep vein thrombosis; Pulmonary embolism; Venous thromboembolism; Venous thrombosis.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Institutional review board statement: The network meta-analysis protocol was registered prospectively under the PROSPERO identification number CRD42024557218, and strict adherence PRISMA checklist was ensured in the preparation of this manuscript. Declaration of Generative AI and AI-assisted technologies in the writing process: The authors declare that no generative AI tools or AI-assisted technologies were used in the preparation of this manuscript.

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram of the study selection process.
Fig. 2
Fig. 2
Risk of bias (RoB) 2 assessment. RoB2 traffic light (A) and RoB2 summary (B) of included RCTs.
Fig. 3
Fig. 3
Summary of main results. Aspirin reduces the risk of venous thromboembolism (VTE) by 20%, deep vein thrombosis (DVT) by 18%, pulmonary embolism (PE) by 21%, and VTE-related mortality by 56% compared with placebo. Illustration elements adapted from Depositphotos™ (licensed image provider), used under extended license permitting academic publication.
See this image and copyright information in PMC

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