Role for aspirin after total hip replacement?

Abstract

Background: Deep vein thrombosis can occur in up to 60% of patients following major orthopaedic surgery. Routine prophylaxis against thromobembolic complications is now the standard of care in this setting. Pharmacological agents used include unfractionated heparin, low molecular weight heparin, factor Xa inhibitors (fondaparinux), vitamin K antagonists and aspirin. Aim: To review the evidence and discuss the use of aspirin as thromboprophylaxis following elective total hip replacement, and consider its use in adult patients who refuse low molecular weight heparin. Method: A literature search was conducted to identify clinical studies, meta-analyses and clinical practice guidelines evaluating the use of aspirin as thromboprophylaxis following elective total hip replacement. Results: No large trials of acceptable quality which specifically compared aspirin with placebo following total hip replacement were identified. Clinical practice guidelines, meta-analyses and one clinical trial assessed aspirin against placebo or other agents used in thromboprophylaxis in major orthopaedic surgery, including elective total hip replacement. Conclusion: There is insufficient evidence to support the use of aspirin alone as thromboprophylaxis following elective total hip replacement.