Patients undergoing joint replacement are at risk for venous thromboembolism (VTE), and most receive anticoagulant therapy after surgery. There is uncertainty, however, about whether to use aspirin or newer anticoagulants. A systematic review and meta-analysis of randomized clinical trials compared the clinical effectiveness and safety of aspirin with that of other anticoagulants for VTE prophylaxis after total hip replacement or total knee replacement.

Thirteen trials with 6,060 participants were included. Of these trials, according to the authors, 11 had a high risk of bias. The relative risk of VTE after total hip replacement or total knee replacement in patients receiving aspirin wasn't significantly different from that of patients receiving other anticoagulants. The findings were similar for deep vein thrombosis and pulmonary embolism.

The risk of adverse events, including wound hematoma, major bleeding, and wound infection, wasn't statistically significantly different with aspirin compared with other agents. Patients receiving aspirin had a lower risk of bruising and lower limb edema. The authors point out that their results weren't affected by any of the clinically relevant study-level characteristics assessed, such as type of joint surgery and anticoagulant used, including low-molecular-weight heparin and rivaroxaban.

They also note that their findings regarding adverse events should be interpreted with caution because of the limited number of studies included. Nonetheless, they conclude that this study's findings are consistent with large observational studies and support the continued use of aspirin for VTE prophylaxis after joint surgery.