Perspective:

Orthopedic surgery, especially THR and TKR, are known to be significant risk factors for VTE. While aspirin has long been known to reduce VTE risk in both primary and secondary prevention, anticoagulation therapy has generally shown better efficacy. However, given concerns about bleeding risk in the postoperative population, surgeons have long advocated for the use of aspirin over anticoagulants (e.g., low molecular weight heparin, rivaroxaban). Of note, the most recent randomized clinical trial including more than half of the total patients did utilize an initial 5-day course of rivaroxaban in all patients before randomizing to aspirin or continued rivaroxaban. All other trials were relatively small or had moderate-high potential for bias. This meta-analysis confirms recent guidelines recommending that aspirin be considered for VTE prophylaxis following THR/TKR in standard-risk patients. Patients at high risk for VTE, including those with prior VTE, likely benefit from anticoagulation prophylaxis.