Aspirin for thromboembolism prophylaxis after fracture surgery

Venous thromboembolism poses a significant risk of fatal complications following fracture surgery. Clinical studies indicated that aspirin is prescribed in thromboprophylaxis but the efficacy and safety are not fully certain yet.

A meta-analysis was conducted to assess the safety and efficacy of aspirin in preventing thromboembolism prophylaxis in patients who have undergone fracture surgery. We searched several databases (Pubmed, Web of Science, and Cochrane Library) up to date January 29, 2023. Only randomized controlled trials were included. Our primary outcomes were all-cause death and bleeding and our secondary outcomes were venous thromboembolism events (pulmonary embolism or deep vein thrombosis) and surgical site infection. Risk ratios (RR), and corresponding 95 % confidence intervals (CI) were used as summary statistics.

Two randomized controlled trials (ADAPT and REVENT CLOT) with 12,540 patients were included in our study. All included studies were of high methodological quality. We found nonsignificant trends towards death (RR = 1.07, 95 %CI = 0.71-1.59), bleeding (RR = 0.96, 95 %CI = 0.89-1.05), pulmonary embolism (RR = 0.96, 95 %CI = 0.72-1.27), and surgical site infection (RR = 1.12, 95 %CI = 0.87-1.46) without heterogeneity. Patients receiving aspirin had a higher risk of deep vein thrombosis (RR = 1.48, 95 %CI = 1.16-1.89) without heterogeneity compared to those receiving enoxaparin at 90-day follow-up. Sub-analyses indicated nonsignificant trends towards massive pulmonary embolism (RR = 0.33, 95 %CI = 0.03-3.21), sub-massive pulmonary embolism (RR = 1.47, 95 %CI = 0.76-2.83), and symptomatic pulmonary embolism (RR = 0.90, 95 %CI = 0.64-1.26).

Although aspirin increased the deep venous thrombosis events, the available data showed no significant difference in all-cause mortality, bleeding, pulmonary embolism, and surgical site infection compared with enoxaparin.