Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact
ABSTRACT Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low‐molecular‐weight heparin (LMW...
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2025-08-01
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| Online Access: | https://doi.org/10.1002/prp2.70147 |
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| author | Eugen Javor Andrej Belančić Patrik Javor Goran Hauser Ivan Kruljac Marko Skelin Andrea Faour Marko Lucijanić |
| author_facet | Eugen Javor Andrej Belančić Patrik Javor Goran Hauser Ivan Kruljac Marko Skelin Andrea Faour Marko Lucijanić |
| author_sort | Eugen Javor |
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| description | ABSTRACT Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low‐molecular‐weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non‐inferior to LMWH for all‐cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of $35,912,459 to $110,431,241 for U.S. healthcare stakeholders, and $17,075 to $56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost‐effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk. |
| format | Article |
| id | doaj-art-b804cf777c624a7daa5e35e6513b180e |
| institution | Kabale University |
| issn | 2052-1707 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | Pharmacology Research & Perspectives |
| spelling | doaj-art-b804cf777c624a7daa5e35e6513b180e2025-08-20T03:36:14ZengWileyPharmacology Research & Perspectives2052-17072025-08-01134n/an/a10.1002/prp2.70147Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget ImpactEugen Javor0Andrej Belančić1Patrik Javor2Goran Hauser3Ivan Kruljac4Marko Skelin5Andrea Faour6Marko Lucijanić7Solmed Clinic Zagreb CroatiaDepartment of Basic and Clinical Pharmacology With Toxicology University of Rijeka, Faculty of Medicine Rijeka CroatiaGeneral Hospital Sisak Sisak CroatiaFaculty of Medicine University of Rijeka Rijeka CroatiaSolmed Clinic Zagreb CroatiaDepartment of Basic and Clinical Pharmacology With Toxicology University of Rijeka, Faculty of Medicine Rijeka CroatiaVancouver Coastal Health Vancouver British Columbia CanadaSchool of Medicine University of Zagreb Zagreb CroatiaABSTRACT Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low‐molecular‐weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non‐inferior to LMWH for all‐cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of $35,912,459 to $110,431,241 for U.S. healthcare stakeholders, and $17,075 to $56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost‐effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk.https://doi.org/10.1002/prp2.70147aspirinlow‐molecular‐weight heparinorthopedicsthromboprophylaxis |
| spellingShingle | Eugen Javor Andrej Belančić Patrik Javor Goran Hauser Ivan Kruljac Marko Skelin Andrea Faour Marko Lucijanić Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact Pharmacology Research & Perspectives aspirin low‐molecular‐weight heparin orthopedics thromboprophylaxis |
| title | Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact |
| title_full | Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact |
| title_fullStr | Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact |
| title_full_unstemmed | Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact |
| title_short | Aspirin Versus LMWH for Thromboprophylaxis Following Hip or Knee Arthroplasty—Clinical Implications and Budget Impact |
| title_sort | aspirin versus lmwh for thromboprophylaxis following hip or knee arthroplasty clinical implications and budget impact |
| topic | aspirin low‐molecular‐weight heparin orthopedics thromboprophylaxis |
| url | https://doi.org/10.1002/prp2.70147 |
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