Journal Article Systematic Review Comparative Study Ppublish
PubMed: 40620160 DOI: 10.1002/prp2.70147
Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty-Clinical Implications and Budget Impact.
Pharmacol Res Perspect 13(4):e70147
Authors: Eugen Javor, Andrej Belančić, Patrik Javor, Goran Hauser, Ivan Kruljac, Marko Skelin, Andrea Faour, Marko Lucijanić
Affiliations
- Solmed Clinic, Zagreb, Croatia.
- Department of Basic and Clinical Pharmacology With Toxicology, University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
- General Hospital Sisak, Sisak, Croatia.
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
- Department of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia.
- Solmed Clinic, Zagreb, Croatia. Medical School, of the Catholic University of Croatia, Zagreb, Croatia.
- Pharmacy Department, General Hospital Šibenik, Šibenik, Croatia.
- Vancouver Coastal Health, Vancouver, British Columbia, Canada.
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Division of Hematology, Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia.
Abstract
Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low-molecular-weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non-inferior to LMWH for all-cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of 35,912,459 to 110,431,241 for U.S. healthcare stakeholders, and 17,075 to 56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost-effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk.
MeSH
Arthroplasty, Embolism, Hemorrhage, Aspirin, Orthopedics, Budgets, Heparin, Low-Molecular-Weight, Arthroplasty, Replacement, Knee