For VTE Prevention, Best Anticoagulant Varies by Surgery

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For VTE Prevention, Best Anticoagulant Varies by Surgery
For VTE Prevention, Best Anticoagulant Varies by Surgery

(HealthDay News) — Aspirin may be less preferable to other anticoagulants following hip fracture repair, but may be favored after elective knee or hip arthroplasty, according to a meta-analysis published online July 17 in the Journal of Hospital Medicine.

Frank S. Drescher, MD, from the Geisel School of Medicine at Dartmouth in White River Junction, VT, and colleagues conducted a systematic literature review to identify randomized trials comparing aspirin to anticoagulants for prevention of venous thromboembolism (VTE) following major lower extremity orthopedic surgery.

The researchers identified eight trials (1,408 participants) that met inclusion criteria. Deep venous thrombosis rates did not differ statistically between aspirin and anticoagulants (relative risk [RR], 1.15; 95% confidence interval [CI], 0.68–1.96). There was a nonsignificant trend favoring anticoagulation following hip fracture repair (RR, 1.60; 95% CI, 0.80–3.20; two trials), but not knee or hip arthroplasty (RR, 1.00; 95% CI, 0.49–2.05; five trials). With aspirin, the risk of bleeding was lower than anticoagulants following hip fracture repair (RR, 0.32; 95% CI, 0.13–0.77; two trials) and nonsignificantly lower after arthroplasty (RR, 0.63; 95% CI, 0.33–1.21; five trials).

"Definitive recommendations for or against the use of aspirin instead of anticoagulation for VTE prevention following major orthopedic surgery are not possible," the authors write.

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