Aspirin Is as Effective as Oral Anticoagulants for Venous Thromboembolism Prophylaxis After Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

The purpose of our study was to assess the effectiveness and safety of aspirin for venous thromboembolism (VTE) prophylaxis after knee arthroplasty. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were two independent researchers who conducted literature searches based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies comparing aspirin and oral anticoagulants (OACs) for VTE prophylaxis after knee arthroplasty. Our meta-analysis included seven randomized controlled trials with 2,323 participants. The relative risk (RR) of VTE following knee arthroplasty was 1.29 (95% confidence interval [CI], 0.78 to 2.14) when comparing aspirin to OACs. Similar results were observed for deep vein thrombosis (RR, 1.33; 95% CI, 0.71 to 2.50) and pulmonary embolism (RR, 1.01; 95% CI, 0.25 to 4.03). No notable differences were found in bleeding, wound complications, or mortality between two groups. Analyses of subgroups based on factors like region, publication year, VTE type, VTE events, aspirin dose, comparator types, use of mechanical thrombosis prophylaxis, trial quality, and study support revealed no substantial differences in VTE incidence between two groups. Overall, the quality of evidence for VTE and deep vein thrombosis outcomes was moderate. Existing randomized controlled trial evidence suggests that aspirin is equally effective and safe as OACs in preventing VTE.