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

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: This work was supported by Enze Medical Center (Group) Scientific Research (No. 23EZA04) and Zhejiang Medicine and Health Scientific Research Project (No. 2024KY531). The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I369 ). 6. J Bone Joint Surg Am. 2024 Jul 17;106(14):1256-1267. doi: 10.2106/JBJS.23.01158. Epub 2024 May 16. Low-Dose Aspirin Is the Safest Prophylaxis for Prevention of Venous Thromboembolism After Total Knee Arthroplasty Across All Patient Risk Profiles. Lavu MS(1)(2), Porto JR(1)(2), Hecht CJ 2nd(1)(2), Acuña AJ(3), Kaelber DC(4)(5), Parvizi J(6), Kamath AF(2). Author information: (1)Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, Ohio. (2)Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. (3)Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois. (4)Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio. (5)Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio. (6)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania. BACKGROUND: The International Consensus Meeting on Venous Thromboembolism (ICM-VTE) in 2022 proclaimed low-dose aspirin as the most effective agent in patients across all risk profiles undergoing joint arthroplasty. However, data on large patient populations assessing trends in chemoprophylactic choices and related outcomes following total knee arthroplasty (TKA) remain scant. The present study was designed to characterize the clinical use of various chemoprophylactic agents in patients undergoing TKA and to determine the efficacy of aspirin compared with other agents in patient groups stratified by VTE risk profiles. METHODS: This study utilized a national database to determine the proportion of patients undergoing TKA who received low-dose aspirin versus other chemoprophylaxis between 2012 and 2022. VTE risk profiles were determined on the basis of comorbidities established in the ICM-VTE. The odds ratios (ORs) and 95% confidence intervals (CIs) between various classes of thromboprophylaxis in patients with high and low risk of VTE were calculated. The odds of deep-vein thrombosis (DVT), pulmonary embolus (PE), bleeding events, infections, mortality, and hospitalizations were also assessed in the 90-day postoperative period for propensity-matched cohorts receiving low-dose (81 mg) aspirin only versus other prophylaxis, segregating patients by VTE risk profile. RESULTS: A total of 126,692 patients undergoing TKA across 60 health-care organizations were included. The proportion of patients receiving low-dose aspirin increased from 7.65% to 55.29% between 2012 and 2022, whereas the proportion of patients receiving other chemoprophylaxis decreased from 96.25% to 42.98%. Low-dose-aspirin-only use increased to approximately 50% in both high-risk and low-risk populations but was more likely in low-risk populations (OR, 1.17; 95% CI, 1.15 to 1.20) relative to high-risk populations. Both low-risk and high-risk patients in the low-dose-aspirin-only cohorts had decreased odds of DVT, PE, bleeding, infections, and hospitalizations compared with other prophylaxis regimens. CONCLUSIONS: The findings of the present study on a very large population of patients undergoing TKA support the recent ICM-VTE statement by showing that low-dose aspirin is a safe and effective method of prophylaxis in patients across various risk profiles. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.23.01158 PMCID: PMC11254562