[Ortho] Aspirin, Xarelto show no difference in preventing venous thromboembolism after TJA

[Alexander Chelnokov]

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty
David R. Anderson, M.D., Michael Dunbar, M.D., John Murnaghan, M.D., 
Susan R. Kahn, M.D., Peter Gross, M.D., Michael Forsythe, M.D., Stephane 
Pelet, M.D., William Fisher, M.D., Etienne Belzile, M.D., Sean Dolan, 
M.D., Mark Crowther, M.D., Eric Bohm, M.D., et al.

BACKGROUND

Clinical trials and meta-analyses have suggested that aspirin may be 
effective for the prevention of venous thromboembolism (proximal 
deep-vein thrombosis or pulmonary embolism) after total hip or total 
knee arthroplasty, but comparisons with direct oral anticoagulants are 
lacking for prophylaxis beyond hospital discharge.

METHODS

We performed a multicenter, double-blind, randomized, controlled trial 
involving patients who were undergoing total hip or knee arthroplasty. 
All the 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 for 90 days for symptomatic venous 
thromboembolism (the primary effectiveness outcome) and bleeding 
complications, including major or clinically relevant nonmajor bleeding 
(the primary safety outcome).

RESULTS

A total of 3424 patients (1804 undergoing total hip arthroplasty and 
1620 undergoing total knee arthroplasty) were enrolled in the trial. 
Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the 
aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban 
group (difference, 0.06 percentage points; 95% confidence interval 
[CI],−0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for 
superiority). Major bleeding complications occurred in 8 patients 
(0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group 
(difference, 0.18 percentage points; 95% CI,−0.65 to 0.29; P=0.42). 
Clinically important bleeding occurred in 22 patients (1.29%) in the 
aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 
0.30 percentage points; 95% CI,−1.07 to 0.47; P=0.43).

CONCLUSIONS

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. (Funded by the Canadian Institutes 
of Health Research; ClinicalTrials.gov number, NCT01720108.)



http://www.nejm.org/doi/full/10.1056/NEJMoa1712746
Alexander Chelnokov

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