Current Practices and Evidence of Aspirin Usage in Microvascular Surgery: A Systematic Review and Meta-Analysis.

Background: Acetylsalicylic acid (ASA) has been used in reconstructive microsurgery since the inception of the field. However, when compared to placebo groups, its efficacy is not confirmed. In our study, we hypothesize that the utility of ASA postoperatively in microvascular surgery is not associated with improved outcomes.
Methods: A systematic review of the literature was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines. Documentation of antiplatelet regimens and postoperative complications were the primary endpoints.
Results: Four articles met inclusion criteria including a total of 1196 patients. There were 637 patients who received aspirin and 559 patients who did not. The average age was not found to be significantly different between the two groups (p > 0.05). In terms of flap type, patients undergoing DIEP had a significantly higher likelihood of receiving aspirin, whereas patients undergoing fibula flaps had a lower rate of aspirin usage (p < 0.05). TRAM, anterolateral thigh flaps, SIEA, and radial forearm flaps were equally distributed between the two groups (p > 0.05). A total of 317 complications were noted across both groups. Total complication rate, complete flap loss, and venous/arterial thrombosis rate were not found to be significantly different between the two groups (p > 0.05). Hematoma rate was found to be significantly higher in the group receiving aspirin when compared to the control (RR = 1.70, 95% CI 1.19-2.44).
Conclusion: Aspirin usage did not confer significant advantage in preventing postoperative complication rates and increased rates of hematoma formation.
(© 2025 The Author(s). Microsurgery published by Wiley Periodicals LLC.)