Javor Eugen, Belančić Andrej, Javor Patrik, Hauser Goran, Kruljac Ivan, Skelin Marko, Faour Andrea, Lucijanić Marko
Solmed Clinic, Zagreb, Croatia.
Department of Basic and Clinical Pharmacology With Toxicology, University of Rijeka, Faculty of Medicine, Rijeka, Croatia.
Pharmacol Res Perspect. 2025 Aug;13(4):e70147. doi: 10.1002/prp2.70147.
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.
静脉血栓栓塞症（VTE）仍是接受髋关节或膝关节置换术患者的重大担忧，需要在有效的血栓预防和出血风险之间取得平衡。我们旨在比较阿司匹林与低分子量肝素（LMWH）作为该人群术后立即开始使用的唯一血栓预防药物的疗效、安全性和预算影响。首先，我们对来自Ovid MEDLINE、Embase和Cochrane CENTRAL数据库的随机对照试验（RCT）进行了系统评价，评估临床结局和医疗费用。随后，使用从最大的已识别和最新的RCT（CRISTAL试验）及其二次分析中获得的数据进行了简化的预算影响分析。主要结局包括有症状的VTE、出血事件和再次手术率。通过系统检索，七项RCT被认为符合条件，CRISTAL试验提供了最有说服力的证据。阿司匹林在全因死亡率方面不劣于LMWH，但与显著更高的有症状VTE发生率（3.27%对1.76%）和深静脉血栓形成（DVT）相关，主要是远端DVT。预算影响分析显示，尽管阿司匹林每片成本较低，但对于美国医疗利益相关者而言，使用LMWH进行血栓预防每年可节省35912459美元至110431241美元，对于每年进行1000例置换手术的单家医院而言，可节省17075美元至56450美元。总之，与阿司匹林相比，依诺肝素在髋关节和膝关节置换术后的血栓预防方面似乎具有更好的临床疗效和成本效益。这些发现支持在这种情况下优先使用LMWH，同时强调需要进一步研究阿司匹林更高的远端DVT和肺栓塞风险的临床意义。
