{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:35:01Z","timestamp":1755225301588,"version":"3.43.0"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bpspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacology Res &amp; Perspec"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Venous thromboembolism (VTE) remains a significant concern for patients undergoing hip or knee arthroplasty, with a need to balance effective thromboprophylaxis and bleeding risk. We aimed to compare the efficacy, safety, and budget impact of aspirin versus low\u2010molecular\u2010weight heparin (LMWH) as sole thromboprophylactic agents initiated immediately postoperatively in this population. First, we conducted a systematic review of randomized controlled trials (RCTs) from Ovid MEDLINE, Embase, and Cochrane CENTRAL databases, assessing clinical outcomes and healthcare costs. Subsequently, a simplified budget impact analysis was performed using data from the largest identified and most recent RCT (CRISTAL trial) and its secondary analyses. Primary outcomes included symptomatic VTE, bleeding events, and reoperation rates. Through a systematic search, seven RCTs were considered to be eligible, with the CRISTAL trial providing the most compelling evidence. Aspirin was non\u2010inferior to LMWH for all\u2010cause mortality but was associated with a significantly higher symptomatic VTE rate (3,27% vs. 1,76%) and deep vein thrombosis (DVT), predominantly distal DVT. The budget impact analysis revealed that despite aspirin's lower per tablet cost, thromboprophylaxis with LMWH led to annual savings of $35,912,459 to $110,431,241 for U.S. healthcare stakeholders, and $17,075 to $56,450 for single hospitals performing 1000 arthroplasty procedures annually. To conclude, enoxaparin appears to offer superior clinical efficacy and cost\u2010effectiveness compared to aspirin for thromboprophylaxis following hip and knee arthroplasty. These findings support the preferential use of LMWH in this setting, while highlighting the need for further investigation into the clinical significance of aspirin's higher distal DVT and pulmonary embolism risk.<\/jats:p>","DOI":"10.1002\/prp2.70147","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T04:32:51Z","timestamp":1751862771000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aspirin Versus <scp>LMWH<\/scp> for Thromboprophylaxis Following Hip or Knee Arthroplasty\u2014Clinical Implications and Budget Impact"],"prefix":"10.1002","volume":"13","author":[{"given":"Eugen","family":"Javor","sequence":"first","affiliation":[{"name":"Solmed Clinic  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-6600","authenticated-orcid":false,"given":"Andrej","family":"Belan\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Pharmacology With Toxicology University of Rijeka, Faculty of Medicine  Rijeka Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrik","family":"Javor","sequence":"additional","affiliation":[{"name":"General Hospital Sisak  Sisak Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goran","family":"Hauser","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Rijeka  Rijeka Croatia"},{"name":"Department of Internal Medicine Clinical Hospital Centre Rijeka  Rijeka Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Kruljac","sequence":"additional","affiliation":[{"name":"Solmed Clinic  Zagreb Croatia"},{"name":"Medical School of the Catholic University of Croatia  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Skelin","sequence":"additional","affiliation":[{"name":"Department of Basic and Clinical Pharmacology With Toxicology University of Rijeka, Faculty of Medicine  Rijeka Croatia"},{"name":"Pharmacy Department General Hospital \u0160ibenik  \u0160ibenik Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Faour","sequence":"additional","affiliation":[{"name":"Vancouver Coastal Health  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Lucijani\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine University of Zagreb  Zagreb Croatia"},{"name":"Division of Hematology, Department of Internal Medicine Clinical Hospital Dubrava  Zagreb Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"issue":"3","key":"e_1_2_10_2_1","article-title":"Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor Xia Inhibitors","volume":"11","author":"Jones A.","year":"2023","journal-title":"Medical Science"},{"issue":"1","key":"e_1_2_10_3_1","first-page":"CD011762","article-title":"Direct Factor Xa Inhibitors Versus Low Molecular Weight Heparins or Vitamin K Antagonists for Prevention of Venous Thromboembolism in Elective Primary Hip or Knee Replacement or Hip Fracture Repair","volume":"27","author":"Salazar C. 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