Key result
Aspirin matches rivaroxaban for DVT prophylaxis following elective total hip arthroplasty.
Why the study?
Aspirin is safe and effective for VTE prophylaxis following total hip arthroplasty, but inconsistent dosing regimens have been reported in the literature.
Does aspirin 100 mg twice daily prevent venous thromboembolism non-inferiorly to rivaroxaban following primary total hip arthroplasty?
RCT (n=70)
Computer randomization (1:1 ratio)
No
Does aspirin 100 mg twice daily prevent venous thromboembolism non-inferiorly to rivaroxaban following primary total hip arthroplasty?
Aspirin 100 mg twice daily is a safe, effective, and less expensive non-inferior alternative to rivaroxaban for DVT prophylaxis following primary total hip arthroplasty.
Answers are grounded in this paper and cite their sources.
Supports aspirin 100 mg BID as lower-cost option for post-THA VTE prophylaxis; extends RCT evidence versus rivaroxaban.
BACKGROUND: Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA. METHODS: Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications. RESULTS: We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5-1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4-1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8-83.0], Rivaroxaban: 81.0 [79.3-83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0-92.0], Rivaroxaban: 91.5 [88.3-92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29). CONCLUSION: In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs. TRIAL REGISTRATION: Chictr.org, ChiCTR18000202894; http://www.chictr.org.cn/showproj.aspx?proj=33284.
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Ren et al. (2021) conducted an RCT in Venous thromboembolism prophylaxis following primary total hip arthroplasty (n=70). Aspirin vs. Rivaroxaban 10 mg once daily was evaluated on Deep vein thrombosis (DVT) on Doppler ultrasonography (p=0.01 for noninferiority). Aspirin 100 mg twice daily was non-inferior to rivaroxaban for DVT prophylaxis (8.8% vs 8.3%, p=0.01 for noninferiority margin) following elective primary total hip arthroplasty.
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