Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Aspirin vs Rivaroxaban for VTE Prophylaxis

N Engl J Med; 2018 Feb 22; Anderson, et al

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.

Citation:

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.

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