Safety and effectiveness of aspirin and enoxaparin for venous thromboembolism prophylaxis after total hip and knee arthroplasty: a systematic review

Abstract

Background: Patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) are at risk of venous thromboembolism (VTE). Australian orthopaedic guidelines recommend aspirin and low-molecular-weight heparin (e.g. enoxaparin) for VTE prophylaxis; however, there is debate in the international literature around the use of aspirin as VTE prophylaxis. This review assesses the risks and benefits of aspirin compared to enoxaparin as VTE prophylaxis for patients undergoing THA or TKA. Methods: A systematic review was conducted to identify relevant randomized controlled trials. Studies comparing enoxaparin, aspirin and/or placebo for VTE prophylaxis in THA or TKA patients were included. Network meta-analysis (NMA) was performed to calculate risk ratios (RRs) and confidence intervals (CIs). Quality appraisal was conducted by assessing risk of bias and the strength of the evidence. Results: Nine randomized controlled trials were eligible for inclusion. The NMA found no statistically significant differences for the investigated outcomes: total DVT rates (RR = 1.21, 95% CI 0.86, 1.72), symptomatic pulmonary embolism (PE) rates (RR = 1.02, 95% CI 0.02, 50.86), major haemorrhage (RR = 0.97, 95% CI 0.02, 50.99) and wound complication (RR = 0.73, 95% CI 0.17, 3.20). The occurrence of PE was rare. Due to limited data, sub-group analysis was not possible. The overall quality of evidence in the NMA is considered to be very low. Conclusion: This review did not find statistically significant differences between aspirin and enoxaparin. Future studies should identify more evidence, particularly for rare outcomes such as PE, as this might help decision-makers to get consensus on the use of aspirin as VTE prophylaxis.

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

“…Once it falls off, it can easily cause pulmonary embolism, and severe cases can lead to death. The relevant guidelines[ 9 , 10 ] point out that patients who have undergone major operations such as hip replacement without obvious bleeding tendency need to use anticoagulant drugs within 24 h after surgery, but there are still some patients who have DVT under the condition of standardized anticoagulant application. At present, there are many reports[ 11 , 12 ] on DVT of the lower extremities after THA at home and abroad, but there are few studies on systemic analysis of DVT after artificial hip replacement, and the risk factors reported in related studies are relatively limited.…”

One Size Does Not Fit All: Venous Thromboembolism Prophylaxis in Colorectal Cancer

“…In the orthopedic surgery literature, there has been ongoing research about patients undergoing total hip arthroplasty or total knee arthroplasty taking both aspirin and enoxaparin, and some orthopedic guidelines currently recommend this combined regimen. 6 The limitations of this study are the fact that it is a retrospective case series at a single institution consisting of only 18 patients. Furthermore, we do not have the resources for obtaining anti-Xa levels, which could have helped to triage patients into a different VTE prophylaxis arm after surgery.…”

“…In the orthopedic surgery literature, there has been ongoing research about patients undergoing total hip arthroplasty or total knee arthroplasty taking both aspirin and enoxaparin, and some orthopedic guidelines currently recommend this combined regimen. 6 …”

Aspirin as venous thromboembolic event prophylaxis post total hip and knee arthroplasty

“…In this issue of the ANZ Journal of Surgery , Nadi et al . report the findings of a network meta‐analysis (NMA) of the safety and effectiveness of aspirin and enoxaparin used as prophylaxis for venous thromboembolic events (VTE, in the form of deep venous thrombosis or pulmonary embolus) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) . This NMA is topical, as both drugs are commonly used in Australia and guidelines are contradictory regarding the use of aspirin …”

“…The study by Nadi et al . investigates the efficacy and safety of aspirin and enoxaparin using the NMA study design – combining results from many studies . The authors conclude that there is no statistically significant difference in the rates of VTE rates between aspirin and enoxaparin post THA and TKA.…”