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Aspirin is a safe and effective thromboembolic prophylaxis after total knee arthroplasty: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patients undergoing total knee arthroplasty (TKA) are at high risk for thromboembolic events compared to non-surgical patients. Both anticoagulants and antiplatelet agents are used as antithrombotic prophylaxis in TKA. The aim of this review is to understand the role of aspirin in the prevention of thromboembolic events and to compare its efficacy and safety with the main anticoagulants used in antithromboembolic prophylaxis in TKA.

Methods

A systematic review and meta-analysis was performed according to the PRISMA guidelines. An electronic systematic search was conducted using PubMed, Scopus, and the Cochrane Central Registry to evaluate studies that compared aspirin with other anticoagulants, in terms of deep venous thrombosis and pulmonary embolism after TKA. The meta-analysis compared the rate of complications between aspirin and other anticoagulants.

Results

Thirteen studies were included in the systematic review for a total of 163,983 patients, and 10 studies were included in the meta-analysis. The meta-analysis demonstrated no statistically significant differences between aspirin and other anticoagulants in terms of the rate of deep venous thrombosis (OR 0.93, 95% CI 0.81–1.08, p = 0.35) and pulmonary embolism (OR 0.89, 95% CI 0.56–1.41, p = 0.61).

Conclusion

Aspirin is safe, effective, and not inferior to other main anticoagulants in preventing thromboembolic events following TKA.

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Data availability

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Code availability

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  1. Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy

    Pierangelo Za, Giuseppe Francesco Papalia, Edoardo Franceschetti, Giacomo Rizzello & Rocco Papalia

  2. Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Pierangelo Za, Giuseppe Francesco Papalia, Edoardo Franceschetti, Giacomo Rizzello & Rocco Papalia

  3. Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy

    Paolo Adravanti

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by PZ and GFP. The first draft of the manuscript was written by PZ and GFP, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Za, P., Papalia, G.F., Franceschetti, E. et al. Aspirin is a safe and effective thromboembolic prophylaxis after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 31, 4407–4421 (2023). https://doi.org/10.1007/s00167-023-07500-1

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