Aspirin Versus Other Anticoagulants for the Initial Prevention of Venous Thromboembolism Following Elective Total Hip and Knee Arthroplasty: An Umbrella Review and Meta-Analysis

Abstract

Background: Reducing venous thromboembolism (VTE) events is crucial to improving outcomes following total joint arthroplasties. Aspirin, low-molecular-weight heparin, factor Xa inhibitors, and warfarin have been investigated to prevent VTE after surgery, but the best option remains uncertain. Our study aimed to clarify aspirin's prophylactic role in hip and knee arthroplasty through an umbrella analysis. Methods: PubMed, Web of Science, Scopus, and Embase databases were queried on September 7, 2023, to identify all published systematic reviews and meta-analyses evaluating the efficacy and safety of aspirin in preventing VTE after primary or revision total hip and total knee arthroplasties. The methodological quality of the included studies was assessed using the A Measurement Tool to Assess Systematic Reviews 2 critical appraisal tool. There were two independent reviewers who extracted data focusing on thromboembolic events, bleeding, and mortality rates. Results: There were 19 systematic reviews and meta-analyses included. The overall risk of deep venous thrombosis was comparable in the aspirin versus nonaspirin group (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 0.86 to 1.68). Aspirin reduced the risk of pulmonary emboli by 0.58%, while other anticoagulants showed a similar reduction of 0.6%, which was not statistically significant (OR = 1.26; 95% CI = 0.76 to 2.07; I2 = 94%). Aspirin significantly reduced total bleeding risk by 30% compared to other anticoagulants (0.33 versus 1.05%; OR = 0.7; 95% CI = 0.58 to 0.85; I2 = 2%). The all-cause mortality rate did not significantly differ between aspirin (0.18%) and other anticoagulants (0.14%) (OR = 1.25; 95% CI = 0.79 to 1.97). Conclusions: Aspirin is a viable chemoprophylactic option following primary or revision total hip and knee arthroplasty due to its availability, cost-effectiveness, ease of administration, lack of routine blood monitoring requirement, and comparative effectiveness to other anticoagulants. (c) 2025 Published by Elsevier Inc.