SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicFrontiers / Advances in Regional Anesthesia and Pain Management for Orthopedic Surgery: From Trauma to Elective CareView all articles
Aspirin versus Enoxaparin for Thromboprophylaxis After Total Hip Arthroplasty, Total Knee Arthroplasty, or Hip Fracture Surgery: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Xinjiang Medical University, Ürümqi, China
- 2Shenzhen Second People's Hospital, Shenzhen, China
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Objective: To systematically evaluate the efficacy and safety of aspirin versus enoxaparin for the prevention of venous thromboembolism (VTE) following major orthopedic surgeries. Methods: We systematically searched PubMed, the Cochrane Library, EMbase, CNKI, Wanfang, and VIP databases from their inception until August 2025 for randomized controlled trials (RCTs) and cohort studies comparing aspirin with enoxaparin for thromboprophylaxis in patients undergoing major orthopedic surgeries (total hip/knee arthroplasty, hip fracture surgery). Two researchers independently performed literature screening, data extraction, and risk-of-bias assessment for the included studies. Meta-analysis was conducted using RevMan 5.3 software. Results: A total of studies involving 117,367 patients (43,441 in the aspirin group and 73,926 in the enoxaparin group) were included. Regarding efficacy, the initial meta-analysis showed no significant difference in the incidence of pulmonary embolism (OR=1.14, 95%CI: 0.66 to 1.95) or deep vein thrombosis (primary analysis: Test for overall effect: Z = 0.43, P = 0.67). However, sensitivity analyses after removing key contributors to heterogeneity revealed that the incidence of DVT was significantly lower in the enoxaparin group (OR=0.78, 95%CI: 0.64 to 0.96, P = 0.02), while the incidence of PE was significantly higher in the aspirin group (sensitivity analysis: Test for overall effect: Z = 2.30, P = 0.02). Regarding safety, the risks of both major bleeding (OR=0.60, 95%CI: 0.40 to 0.89, P = 0.01) and minor bleeding (OR=0.57, 95%CI: 0.49 to 0.66, P < 0.00001) were significantly lower in the aspirin group. No statistically significant differences were found between the two groups in terms of wound complications, 90-day all-cause mortality (primary analysis: OR=0.81, 95%CI: 0.37 to 1.78, P = 0.60), or readmission rates. Conclusion: For patients undergoing major orthopedic surgery, aspirin is comparable to enoxaparin in preventing the primary efficacy outcomes of VTE (pulmonary embolism and deep vein thrombosis) but demonstrates a significant advantage in reducing the risk of minor bleeding. Aspirin represents an effective and safer prophylactic option, particularly for patients with higher bleeding risk profiles.
Keywords: Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Aspirin, Enoxaparin, Hip Fractures, Meta-analysis, Venous Thromboembolism
Received: 18 Jan 2026; Accepted: 06 Feb 2026.
Copyright: © 2026 Haibier, Maimaitiniyazi, Lin, Liu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Wei Liu
Wencui Li
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