Discussion
Pulmonary Embolism, VTE, THA
PULMONARY EMBOLISM, SECONDARY
In this planned secondary analysis from the CRISTAL cluster randomized crossover trial, there was no between-group difference in mortality within 90 days for patients receiving either aspirin or enoxaparin for VTE prophylaxis following hip or knee arthroplasty. Mortality rates were lower in the enoxaparin group for all analyses, although none reached statistical significance. These findings complement the results of the primary study by demonstrating that enoxaparin reduces symptomatic VTE following these procedures, without resulting in an increase in mortality compared with aspirin.Three randomized clinical trials and multiple observational studies have included short-term mortality (either 30 or 90 days) as a secondary outcome when investigating the use of aspirin for VTE prophylaxis following THA or TKA. The results from the 3 randomized trials support our finding of similar mortality outcomes for aspirin vs other chemoprophylaxis agents or placebo in reducing mortality following elective hip or knee arthroplasty. However, none of these trials compared aspirin monotherapy with other agents used for VTE prophylaxis (eg, DOACs, LMWH, or warfarin). The Pulmonary Embolism Prevention (PEP) trial compared aspirin with placebo and demonstrated no between-group difference in all-cause mortality or symptomatic VTE within 90 days for 2648 patients undergoing elective arthroplasty.Three observational studies (including 59 747 patients,The strengths of this study include its prospective design, well-balanced demographic data between groups and broad inclusion criteria with respect to indication for surgery and type of surgery, which increase the generalizability of the results. The protocol was applied to all participating hospitals, and the results reflect the effect of implementing the use of these drugs at a department level.