Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism (VTE), a recent study found. The double-blind, randomized, controlled trial included 3,424 patients; 1,804 were undergoing total hip arthroplasty and 1,620 undergoing total knee arthroplasty. All patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed up for 90 days. Researchers found:
- VTE occurred in 11 of 1,707 patients in the aspirin group and in 12 of 1,707 patients in the rivaroxaban group.
- Major bleeding complications occurred in 8 patients in the aspirin group and in 5 patients in the rivaroxaban group.
- Clinically important bleeding occurred in 22 patients in the aspirin group and in 17 in the rivaroxaban group.
Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018; 378:699-707. doi:10.1056/NEJMoa1712746.