Efficacy and safety of aspirin <i>versus</i> rivaroxaban in the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis_West China Medical Journal

Authors：

WANG Shikun , WANG Yongcai , ZHANG Jian ,  LIU Kai

Department of Joint Surgery, the People’s Hosipital of Leshan, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

LIU Kai, Email: 285061643@qq.com

Keywords：

Aspirin; rivaroxaban; total knee arthroplasty; randomized controlled trial; meta-analysis

DOI：

10.7507/1002-0179.202302032

Video：

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Objective To compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA). Methods Eight databases were searched, including Cochrane Library, Embase, Web of Science, PubMed, SinoMed, Wanfang, Chongqing VIP, and China National Knowledge Infrastructure. The search period was from the establishment of databases to June 2023. All randomized controlled trials of aspirin and rivaroxaban for the prevention of VTE after TKA were collected, and meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 articles were included, with a publication period from 2014 to 2022, including a total of 714 patients, including 356 in the aspirin group and 358 in the rivaroxaban group. The meta-analysis results showed that the incidence of deep venous thrombosis in the lower limbs of the aspirin group was higher than that of the rivasarb group [relative risk (RR)=1.53, 95% confidence interval (CI) (1.09, 2.16), P=0.01], and the incidence of bleeding complications was lower than that of the rivaroxaban group [RR=0.66, 95%CI (0.52, 0.82), P=0.0003]. There was no statistically significant difference in the incidence of wound complications between the two groups (P>0.05). Conclusion The efficacy of rivaroxaban in preventing VTE after TKA is better than that of aspirin, but there is an increased risk of bleeding complications.

Citation： WANG Shikun, WANG Yongcai, ZHANG Jian, LIU Kai. Efficacy and safety of aspirin versus rivaroxaban in the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis. West China Medical Journal, 2023, 38(10): 1490-1494. doi: 10.7507/1002-0179.202302032 Copy

1.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest, 2008, 133(Suppl 6): 381S-453S.
2.	Huang HF, Li SS, Yang XT, et al. Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis. Medicine (Baltimore), 2018, 97(48): e13465.
3.	Rodarte RRP, Guimarães JAM, Franco JS, et al. Systematic review of prophylaxis for venous thromboembolism after knee arthroplasty: enoxaparin versus rivaroxaban. Rev Col Bras Cir, 2019, 46(2): e2075.
4.	Zou Y, Tian S, Wang Y, et al. Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty. Blood Coagul Fibrinolysis, 2014, 25(7): 660-664.
5.	陈顺兴, 罗伟, 王广辉. 比较阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成的疗效和安全性. 北方药学, 2015(7): 124-125.
6.	郝明, 李文雅. 阿司匹林与利伐沙班预防全膝关节置换后下肢深静脉血栓的临床对照研究. 药物评价研究, 2017, 40(6): 824-827.
7.	Colleoni JL, Ribeiro FN, Mos PAC, et al. Venous thromboembolism prophylaxis after total knee arthroplasty (TKA): aspirin vs. rivaroxaban. Rev Bras Ortop, 2017, 53(1): 22-27.
8.	陈治学, 殷力, 张翼, 等. TKA 术后应用阿司匹林、低分子肝素钙和利伐沙班预防 VTE 疗效分析. 医药论坛杂志, 2019, 40(3): 31-33.
9.	Hongnaparak T, Janejaturanon J, Iamthanaporn K, et al. Aspirin versus rivaroxaban to prevent venous thromboembolism after total knee arthroplasty: a double-blinded, randomized controlled trial. Rev Bras Ortop (Sao Paulo), 2021, 57(5): 741-746.
10.	刘丹, 潘宏. 阿司匹林在 TKA 术后预防静脉血栓栓塞中作用的研究. 中外医疗, 2022, 41(3): 129-132.
11.	Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(Suppl 2): e278S-e325S.
12.	中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
13.	乌兰, 党永康, 杨柳. 下肢深静脉血栓抗凝药物研究进展. 血管与腔内血管外科杂志, 2017, 3(3): 795-799.
14.	Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(Suppl 2): e637S-e668S.
15.	Faour M, Piuzzi NS, Brigati DP, et al. Low-dose aspirin is safe and effective for venous thromboembolism prophylaxis following total knee arthroplasty. J Arthroplasty, 2018, 33(7S): S131-S135.
16.	Za P, Papalia GF, 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, 2023, 31(10): 4407-4421.
17.	Matharu GS, Kunutsor SK, Judge A, et al. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med, 2020, 180(3): 376-384.
18.	谢锦伟, 岳辰, 马俊, 等. 初次髋膝关节置换术后静脉血栓发生情况的观察比较. 中国骨伤, 2016, 29(8): 708-712.
19.	Hu B, Jiang L, Tang H, et al. Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: a meta-analysis. J Orthop Surg Res, 2021, 16(1): 135.
20.	Mahady SE, Margolis KL, Chan A, et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut, 2021, 70(4): 717-724.
21.	Xu J, Kanagaratnam A, Cao JY, et al. A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: a meta-analysis. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019896024.

1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest, 2008, 133(Suppl 6): 381S-453S.
2. Huang HF, Li SS, Yang XT, et al. Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis. Medicine (Baltimore), 2018, 97(48): e13465.
3. Rodarte RRP, Guimarães JAM, Franco JS, et al. Systematic review of prophylaxis for venous thromboembolism after knee arthroplasty: enoxaparin versus rivaroxaban. Rev Col Bras Cir, 2019, 46(2): e2075.
4. Zou Y, Tian S, Wang Y, et al. Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty. Blood Coagul Fibrinolysis, 2014, 25(7): 660-664.
5. 陈顺兴, 罗伟, 王广辉. 比较阿司匹林和利伐沙班预防全膝关节置换后下肢深静脉血栓形成的疗效和安全性. 北方药学, 2015(7): 124-125.
6. 郝明, 李文雅. 阿司匹林与利伐沙班预防全膝关节置换后下肢深静脉血栓的临床对照研究. 药物评价研究, 2017, 40(6): 824-827.
7. Colleoni JL, Ribeiro FN, Mos PAC, et al. Venous thromboembolism prophylaxis after total knee arthroplasty (TKA): aspirin vs. rivaroxaban. Rev Bras Ortop, 2017, 53(1): 22-27.
8. 陈治学, 殷力, 张翼, 等. TKA 术后应用阿司匹林、低分子肝素钙和利伐沙班预防 VTE 疗效分析. 医药论坛杂志, 2019, 40(3): 31-33.
9. Hongnaparak T, Janejaturanon J, Iamthanaporn K, et al. Aspirin versus rivaroxaban to prevent venous thromboembolism after total knee arthroplasty: a double-blinded, randomized controlled trial. Rev Bras Ortop (Sao Paulo), 2021, 57(5): 741-746.
10. 刘丹, 潘宏. 阿司匹林在 TKA 术后预防静脉血栓栓塞中作用的研究. 中外医疗, 2022, 41(3): 129-132.
11. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(Suppl 2): e278S-e325S.
12. 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南. 中华骨科杂志, 2016(2): 65-71.
13. 乌兰, 党永康, 杨柳. 下肢深静脉血栓抗凝药物研究进展. 血管与腔内血管外科杂志, 2017, 3(3): 795-799.
14. Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2012, 141(Suppl 2): e637S-e668S.
15. Faour M, Piuzzi NS, Brigati DP, et al. Low-dose aspirin is safe and effective for venous thromboembolism prophylaxis following total knee arthroplasty. J Arthroplasty, 2018, 33(7S): S131-S135.
16. Za P, Papalia GF, 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, 2023, 31(10): 4407-4421.
17. Matharu GS, Kunutsor SK, Judge A, et al. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med, 2020, 180(3): 376-384.
18. 谢锦伟, 岳辰, 马俊, 等. 初次髋膝关节置换术后静脉血栓发生情况的观察比较. 中国骨伤, 2016, 29(8): 708-712.
19. Hu B, Jiang L, Tang H, et al. Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: a meta-analysis. J Orthop Surg Res, 2021, 16(1): 135.
20. Mahady SE, Margolis KL, Chan A, et al. Major GI bleeding in older persons using aspirin: incidence and risk factors in the ASPREE randomised controlled trial. Gut, 2021, 70(4): 717-724.
21. Xu J, Kanagaratnam A, Cao JY, et al. A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: a meta-analysis. J Orthop Surg (Hong Kong), 2020, 28(1): 2309499019896024.

West China Medical Journal

Efficacy and safety of aspirin versus rivaroxaban in the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis

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