A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: A meta-analysis

Abstract

Purpose: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients are at an elevated risk of post-operative venous thromboembolism (VTE). Newer thromboprophylactic agents such as rivaroxaban are increasingly used and effective in preventing thromboembolic events but may worsen bleeding risk. Recent studies have suggested that the more cost-effective aspirin may also be effective in preventing VTE. This systematic review and meta-analysis aimed to compare the efficacy of aspirin against rivaroxaban for the prevention of VTE following TKA and THA. Methods: Electronic searches were performed using five databases from their date of inception to August 2018. Relevant studies were identified, with data extracted and meta-analyzed from the studies. Results: Five studies were included, which consisted of 2257 in the aspirin group and 2337 in the rivaroxaban group. There were no differences between aspirin and rivaroxaban for either VTE (p ¼ 0.48) or its components deep vein thrombosis (p ¼ 0.44) and pulmonary embolism (p ¼ 0.98). Also, there were no differences between groups for either major bleeding (p ¼ 0.17), any bleeding (p ¼ 0.62), readmissions (p ¼ 0.37) or wound complications (p ¼ 0.17). Conclusion: Aspirin was not significantly different to rivaroxaban for prevention of VTE or adverse events after TKA or THA. However, this study was limited by the significant heterogeneity of the included studies. More large randomized studies are needed to add to this body of evidence.

Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: a meta-analysis

“…As a matter of fact, the American Association of Orthopaedic Surgery recommends aspirin as a chemoprophylactic drug for VTE in 2012 [ 21 ]. In addition, other recent studies have shown that aspirin did not differ statistically significantly from other anticoagulants used for VTE prophylaxis after THA and TKA [ 22 – 24 ]. These studies support our conclusion.…”

Meta-Analysis: A Comparison of Aspirin and Rivaroxaban for Prophylaxis of Venous Thromboembolism After Hip or Knee Arthroplasty.

“…According to Chung et al 268 Korean patients from May 2011 to November 2013 undergoing total knee replacement were carried out. Divided into groups that received 100mg aspirin and the others who received 10 mg rivaroxaban were followed up postoperatively [11]. The incidence of overall venous thromboembolism was not signi cant.…”

Time for an Update? A Look at Current Guidelines for Venous Thromboembolism Prophylaxis After Hip and Knee Arthroplasty and Hip Fracture

“…There is much focus on one agent over another, but the real challenge is determining the appropriate threshold of risk factors for the use of a given agent in a particular patient. For TJA, recent data [8][9][10][11][12][13][14][15][16] support that aspirin is appropriate for most patients with modern pain management and mobilization protocols. Low-dose aspirin appears to be sufficient [27,28].…”

“…The optimal chemoprophylactic agent would minimize both the risks of VTE and bleeding, while being cost-effective and easy to administer. While no single medication has yet to be identified, aspirin, for example, has been gaining clinical acceptance for prophylaxis after TJA as its safety and efficacy have been demonstrated repeatedly [8][9][10][11][12][13]. A recent systematic review and meta-analysis of randomized controlled trials found no difference in VTE or adverse events when comparing aspirin with other anticoagulants after TJA [14].…”