Pharmacological prophylaxis of choice in venous thromboembolic disease in major orthopedic surgery: aspirin vs LMWH and other anticoagulants

Introduction: Venous thromboembolic disease, deep vein thrombosis and pulmonary embolism are important causes of long-term morbidity and mortality, and are preventable. The risk of VTE is established in patients who will undergo major orthopedic surgery, given by factors such as the duration of surgery and reduced perioperative mobility. Studies show that without pharmacological thrombo prophylaxis, VTE rates are significant. For this reason, it is essential to establish an effective thrombo prophylaxis protocol to prevent VTE without significantly increasing the risk of bleeding. There is no evidence with strong results regarding the drug of choice for thrombo prophylaxis, but currently meta-analyses and systematic reviews establish aspirin as an effective, accessible and low-cost option, with low risk of postoperative bleeding in low-risk patients. Aspirin is an easy-to-administer drug, does not require blood monitoring and is well tolerated, with an excellent safety profile. However, there are some theories that newer oral agents may have higher risks of bleeding, such as major hemorrhages and complications from postsurgical wounds. Therefore, there is still considerable debate about which agents should be preferred in terms of effectiveness and lower risk of bleeding. Objectives: To establish the drug of choice for thromboprophylaxis in VTE in patients undergoing major orthopedic surgery. Materials and methods: A bibliographic search and analysis was carried out, only 15 articles were suitable for the research, articles from international databases such as PubMed, Scopus and Cinahl were used. Results: There were no significant differences in the risk of VTE (OR = 0.93; 95% CI: 0.69-1.26; p = 0.64), DVT (OR = 0.72; 95% CI: 0.43-1.20; p = 0.21) or PTE (OR = 1.13; 95% CI: 0.86-1.49; p = 0.38) between the groups that received LMWH prophylaxis and those that received aspirin. Nor were significant differences found in mortality (p = 0.30), bleeding (p = 0.22), or surgical wound complications (p = 0.85) between the two groups. Conclusion: aspirin is at least as safe and effective a drug for thromboprophylaxis as OACs and LMWH.