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Acetylsalicylic Acid for Venous Thromboembolism Prophylaxis in Total Hip or Knee Replacement: A Review of Clinical Effectiveness and Guidelines

Last updated: August 31, 2020
Project Number: RC1304-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of acetylsalicylic acid for venous thromboembolism prophylaxis in individuals undergoing total hip or knee replacement?
  2. What are the evidence-based guidelines regarding the use of acetylsalicylic acid for venous thromboembolism prophylaxis in individuals undergoing total hip or knee replacement?

Key Message

This review included five systematic reviews of randomized controlled trials, 15 non-randomized studies (i.e., 14 retrospective and one prospective in design) regarding the clinical effectiveness and safety of ASA for venous thromboembolism prophylaxis in patients undergoing total hip or knee arthroplasty, and three evidence-based guidelines regarding the use of aspirin in this population.In terms of effectiveness and safety profile, the use of ASA for venous thromboembolism prophylaxis after total hip or knee arthroplasty was generally not associated with significant differences compared to alternative anticoagulants including low molecular weight heparins (enoxaparin, dalteparin), Factor Xa inhibitors (rivaroxaban, apixaban), direct thrombin inhibitor (dabigatran), warfarin, or another anticoagulants. All three included guidelines recommend the use of aspirin for venous thromboembolism prophylaxis in patients undergoing total hip or knee arthroplasty based on low quality evidence. Due to significant limitations of the evidence, interpretations of the findings should be taken with cautions.