Clinical effectiveness and safety of aspirin and other anticoagulants for venous thromboembolism prophylaxis after major orthopedic surgery: a systematic review and meta-analysis of randomized clinical trials

Patients undergoing major orthopedic surgeries, such as total hip replacement (THR), total knee replacement (TKR), and trauma surgery (hip/femur fracture), are at an elevated risk of venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common forms of VTE incidence, causing significant morbidity and mortality (1). VTE in major orthopedic surgery is caused by several prothrombotic mechanisms, such as vein injury, coagulation activation due to bone and tissue injury, heat from cement polymerization, and prolonged immobilization (2, 3). Recent studies from 363 530 patients showed an overall incidence of VTE in patientswho underwent THR and TKR as 0.6 and 1.4%, respectively (4). It accounts for 1 in 167 patients undergoing THR and 1 in 71 patients undergoing TKR (4). The incidence of DVT is also quite similar in patients undergoing orthopedic trauma surgery, accounting for 0.84% (5).