State-of-the-Art evidence-based review of aspirin for thromboprophylaxis in modern elective total hip and kneearthroplasty

Abstract

Objective There is uncertainty regarding the optimal means of thromboprophylaxis following total hip and knee arthroplasty (THA, TKA). This systematic evidence-based review presents the evidence for acetylsalicylic acid (aspirin) as a thromboprophylactic agent in THA and TKA and compares it with other chemoprophylactic agents. Methods A search of literature published between January 2004 and September 2017 was performed in the database including NHS、TRIP、Cochrane, MEDLINE and EMBASE in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 14 studies were eligible for inclusion including 5 level I evidence studies and 9 level Ⅲ evidence studies; Evidence from one good quality randomized controlled trial (RCT) showed no difference in rates of venous thrombo-embolism (VTE) in patients given aspirin or low molecular weight heparin (LMWH) following TKA. There was insufficient evidence from trials with moderate to severe risk of bias being present to suggest aspirin is more or less effective than LMWH, warfarin or dabigatran for the prevention of VTE in TKA or THA. Compared with aspirin, rates of asymptomatic deep vein thrombosis (DVT) in TKA may be reduced with rivaroxaban but insufficient evidence exists to demonstrate an effect on incidence of symptomatic DVT. Compared with aspirin there is evidence of more wound complications following THA and TKA with dabigatran and in TKA with rivaroxaban. Conclusions The results suggest aspirin may be a suitable alternative to other thrombo prophylactic agents following THA and TKA. Further investigation is required to fully evaluate the safety and efficacy of aspirin. Key words: Aspirin; Arhtroplasty, replacement, hip; Arthroplasty, replacement, knee; Venous thromboembolism