title: Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty.
abstract: OBJECTIVE
  There is uncertainty regarding the optimal means of thromboprophylaxis following total hip and knee arthroplasty (THA, TKA). This systematic 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 2004 and 2014 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 13 studies were eligible for inclusion.
  
  
  RESULTS
  Evidence from one good quality randomised 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. Some studies highlighted concerns over bleeding complications and efficacy of aspirin.
  
  
  CONCLUSIONS
  The results suggest aspirin may be considered a suitable alternative to other thromboprophylactic agents following THA and TKA. Further investigation is required to fully evaluate the safety and efficacy of aspirin. Cite this article: Bone Joint J 2016;98-B:1056-61.
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Department of Trauma and Orthopaedics, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: D G G
authors.initials: DG
authors.lastname: Wilson
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
authors.forename: W E C
authors.initials: WE
authors.lastname: Poole
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Chauhan
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, East Sussex, BN2 5BE, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Rogers
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001241:Aspirin / Q000627:therapeutic use*; D002985:Clinical Protocols; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D054556:Venous Thromboembolism / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D001241:Aspirin
keywords: Aspirin; Deep vein thrombosis; Thromboprophylaxis; Total hip arthroplasty; Total knee arthroplasty