Efficacy and safety of high-dose and low-dose aspirin in preventing venous thromboembolism after total joint arthroplasty:a Meta-analysis
Objective To evaluate the efficacy and safety of low-dose aspirin and high-dose aspirin in preventing venous thromboembolism after total joint arthroplasty.Methods We searched PubMed,Web of Science,Wanfang Database,and CNKI full-text database to collect clinical control studies on the efficacy and safety of low-dose aspirin and high-dose aspirin in preventing venous thromboembolism after total joint arthroplasty from the establishment of the database to April 2023 based on the inclusion and exclusion criteria.The data of the studies were analyzed by RevMan 5.4 software.Results The Meta-analysis included a total of 10 studies involving 59 106 samples,including 22 591 in the low-dose aspirin group(81 mg bid)and 36 515 in the high-dose aspirin group(325 mg bid).Meta analysis showed that the incidence rate of postoperative VTE(OR=0.65,95%CI:0.48-0.88,P=0.006),DVT(OR=0.61,95%CI:0.42-0.89,P=0.01),and infection(OR=0.37,95%CI:0.21-0.66,P=0.0006)were lower in the low-dose aspirin group when compared to the high-dose aspirin group,with statistically significant differences.There was no statistically significant difference in the incidence rate of postoperative PE,bleeding events,and mortality(P>0.05).The results of subgroup analysis showed that in the primary arthroplasty,the risk of occurrence of postoperative VTE(OR=0.68,95%CI:0.50-0.93,I2=0%,P=0.02),DVT(OR=0.59,95%CI:0.40-0.87,I2=41%,P=0.007),and infection(OR=0.33,95%CI:0.17-0.63,I2=0%,P=0.0008)in the low-dose aspirin group were lower than those in the high-dose aspirin group.In revision arthroplasty,the risk of occurrence of postoperative complications in the low-dose aspirin group was similar with that in the high-dose aspirin group.Conclusions Compared with the high-dose aspirin,low-dose aspirin can significantly reduce the incidence rate of postoperative VTE,DVT,and infection after total joint arthroplasty.There are no significant differences in PE,bleeding events and mortality between the two groups.However,the efficacy of low-dose aspirin may be limited in patients of revision arthroplasty.
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