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Еще один шаг назад от агрессивности к консервативному аспирину:

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Aspirin for VTE Prophylaxis After Hip and Knee Surgery
Feb 04, 2020

Results:
The authors identified 13 randomized clinical trials inclusive of 6,060 patients. The overall relative risk for postoperative VTE was 1.12 (95% confidence interval [CI], 0.78-1.62) for aspirin compared to anticoagulation therapy. Similar risk was seen for deep vein thrombosis (relative risk [RR], 1.04; 95% CI, 0.72-1.51) and pulmonary embolism (RR, 1.01; 95% CI, 0.68-1.48). The risk of adverse events was not different between aspirin and anticoagulation therapy.

Conclusions:
The authors concluded that aspirin did not differ significantly from anticoagulation therapy for the prevention of postoperative VTE following THR or TKR.

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.