Effectiveness and Safety of Aspirin Versus Other Antithrombotics for VTE After Total Hip and Knee Arthroplasty in Real-World Setting.

BackgroundVenous thromboembolism (VTE) is a potentially life-threatening complication in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Multiple antithrombotic agents are routinely used to prevent VTE after THA and TKA. However, it remains unclear which anticoagulant is optimal in real-world clinical practice. This study aimed to assess the effectiveness and safety of aspirin and other antithrombotic agents for VTE prophylaxis following THA and TKA.MethodsSeveral electronic databases, including PubMed, Embase, and the Cochrane Library, were systematically searched from inception to January 13th, 2025. The search identified real-world studies assessing the efficacy or safety of aspirin versus other anticoagulants for VTE prophylaxis after THA or TKA. The pooled rate of thromboembolic and bleeding events was estimated using a random-effects model. Two reviewers independently screened the literature and extracted data. Subgroup analyses were conducted based on study type, dose regimen and geographic region.ResultsA total of 41 studies were identified for inclusion. The overall incidence of VTE after THA and TKA with low-molecular-weight heparin (LMWH) was 1.20% (95% CI: 0.90%-1.60%). The incidence of VTE for aspirin, warfarin and direct oral anticoagulants (DOACs) was 0.80%, 0.9% and 0.90%, respectively. The pooled incidence of major bleeding for aspirin (1.90%, 95% CI: 0.00%-4.60%) was statistically significantly different from that in patients receiving LMWH (3.50%, 95% CI: 0.00%-7.80%) and DOACs (3.10%, 95% CI: 1.20%- 5.00%). When analyzing regional subgroups among several antithrombotic agents, VTE rate was significantly higher in Asia (LMWH: 21.80%, aspirin: 2.40%, DOACs: 9.40%) compared to other regions. In terms of major bleeding, the higher rate associated with DOACs (5.00%, 95% CI: 0.90%-9.20%) was found in North America compared to other regions, especially among patients treated with rivaroxaban (4.10%, 95% CI: 1.20%-7.00%).ConclusionTo date, this study provides the most comprehensive real-world evidence regarding antithrombotic agents for VTE prophylaxis after THA and TKA. Aspirin appears to be as effective as other antithrombotic agents for VTE prophylaxis following THA and TKA. Furthermore, its use is associated with a significantly lower risk of bleeding. Nevertheless, these findings should be interpreted carefully.