Aspirin 'at par' with other anticoagulants used for VTE after THR/TKR: JAMA
UK: Aspirin seemed to be equally safe and effective as the standard anticoagulants used for VTE (venous thromboembolism) prophylaxis after total hip replacement (THR) or total knee replacement (TKR) in a recent review.
According to the study, published in the journal JAMA Internal Medicine, compared with the use of anticoagulants -- low-molecular-weight heparin (LMWH) and rivaroxaban (Xarelto) -- aspirin use was not associated with more major bleeding, wound complications, or death. In fact, aspirin was associated with a reduced risk of bruising and lower-limb edema.
Patients undergoing THR and TKR receive VTE pharmacoprophylaxis but it is not clear which anticoagulant is preferable. Observational studies suggest aspirin to provide effective VTE prophylaxis. Gulraj S. Matharu, Musculoskeletal Research Unit, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom, and colleagues conducted this systematic review and meta-analysis of 13 RCTs to assess the effectiveness and safety of aspirin for VTE prophylaxis after THR and TKR.
The meta-analysis of 13 randomized trials included 6,060 people in total (57.2% women, mean age 63.0 years). Trials with a placebo control group were excluded.
The primary outcome was any postoperative VTE (asymptomatic or symptomatic). Secondary outcomes were adverse events associated with therapy, including bleeding.
Key findings of the study include:
- The RR of VTE after THR and TKR was 1.12 for aspirin compared with other anticoagulants.
- Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04) and pulmonary embolism (PE) (RR, 1.01).
- The risk of adverse events, including major bleeding, wound hematoma, and wound infection, was not statistically significantly different in patients receiving aspirin vs other anticoagulants.
- When analyzing THRs and TKRs separately, there was no statistically significant difference in the risk of VTE, DVT, and PE between aspirin and other anticoagulants.
- Aspirin had a VTE risk not statistically significantly different from low-molecular-weight heparin (RR, 0.76) or rivaroxaban (RR, 1.52).
- The quality of the evidence ranged from low to high.
"Future trials should focus on noninferiority analysis of aspirin compared with alternative anticoagulants and cost-effectiveness," concluded the authors.
The study, "Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement: A Systematic Review and Meta-analysis of Randomized Clinical Trials," is published in the journal JAMA Internal Medicine.
