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, Guimar?es 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.	陳順興, 羅偉, 王廣輝. 比較阿司匹林和利伐沙班預防全膝關節置換后下肢深靜脈血栓形成的療效和安全性. 北方藥學, 2015(7): 124-125.
6.	郝明, 李文雅. 阿司匹林與利伐沙班預防全膝關節置換后下肢深靜脈血栓的臨床對照研究. 藥物評價研究, 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.	陳治學, 殷力, 張翼, 等. TKA 術后應用阿司匹林、低分子肝素鈣和利伐沙班預防 VTE 療效分析. 醫藥論壇雜志, 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.	劉丹, 潘宏. 阿司匹林在 TKA 術后預防靜脈血栓栓塞中作用的研究. 中外醫療, 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.	中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
13.	烏蘭, 黨永康, 楊柳. 下肢深靜脈血栓抗凝藥物研究進展. 血管與腔內血管外科雜志, 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.	謝錦偉, 岳辰, 馬俊, 等. 初次髖膝關節置換術后靜脈血栓發生情況的觀察比較. 中國骨傷, 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, Guimar?es 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. 陳順興, 羅偉, 王廣輝. 比較阿司匹林和利伐沙班預防全膝關節置換后下肢深靜脈血栓形成的療效和安全性. 北方藥學, 2015(7): 124-125.
6. 郝明, 李文雅. 阿司匹林與利伐沙班預防全膝關節置換后下肢深靜脈血栓的臨床對照研究. 藥物評價研究, 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. 陳治學, 殷力, 張翼, 等. TKA 術后應用阿司匹林、低分子肝素鈣和利伐沙班預防 VTE 療效分析. 醫藥論壇雜志, 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. 劉丹, 潘宏. 阿司匹林在 TKA 術后預防靜脈血栓栓塞中作用的研究. 中外醫療, 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. 中華醫學會骨科學分會. 中國骨科大手術靜脈血栓栓塞癥預防指南. 中華骨科雜志, 2016(2): 65-71.
13. 烏蘭, 黨永康, 楊柳. 下肢深靜脈血栓抗凝藥物研究進展. 血管與腔內血管外科雜志, 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. 謝錦偉, 岳辰, 馬俊, 等. 初次髖膝關節置換術后靜脈血栓發生情況的觀察比較. 中國骨傷, 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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