Study Summary

8 studies including 126 367 patients undergoing major orthopaedic surgery were included in this systematic review and meta-analysis comparing aspirin vs enoxaparin for venous thromboembolism (VTE) prophylaxis. Pooled outcomes of interest included pulmonary embolism, deep vein thrombosis, major bleeding, minor bleeding, wound complications, mortality, and readmission rates. Initial analyses demonstrated no significant differences in pulmonary embolism or deep vein thrombosis rates between groups. Aspirin was associated with significantly lower rates of major and minor bleeding, while wound complications, mortality, and readmissions were comparable between groups. Overall, aspirin appeared to provide similar overall thromboembolic protection with a more favourable bleeding profile, supporting its use as an effective prophylactic strategy in selected orthopaedic patients.