Switching Knee Arthroplasty Patients From Anticoagulants to Aspirin

Switching patients from a direct oral anticoagulant to aspirin in the early days after a hip or knee replacement is effective for the prevention of symptomatic venous thromboembolism (VTE), according to the results of a new study led by David Anderson, M.D. of Dalhousie University, Halifax, Canada.

Anderson said, “At the end of the day, it’s a pretty simple clinical question we addressed and I think we pretty clearly demonstrated that aspirin is a good alternative to anticoagulation for this indication. Given the evidence, the cost, the convenience—all of those things—[aspirin] is a choice many patients and surgeons would choose to use.”

While oral anticoagulation for VTE prophylaxis is commonly accepted clinical practice, as well as being supported by guidelines, Anderson said his research group questioned whether practice could be simplified to save money, as well as potentially provide a safer alternative with aspirin. For patients undergoing total hip or total knee arthroplasty, anticoagulant prophylaxis is recommended by many doctors for a minimum of 14 days and as many as 35 days.

Anderson said that given the safety and efficacy of aspirin, the medical community should “take a hard look” at their data for how to best prevent VTE in these surgical patients. “Given the number of people that undergo these procedures, this would be a significant savings to patients and the healthcare system to make this change,” he said. The results of the study, “Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty,” are published in the February 22, 2018, issue The New England Journal of Medicine.