What is the efficacy of thromboprophylaxis against venous thromboembolism (VTE)?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS  more...
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A randomized, controlled trial comparing dalteparin with aspirin for VTE prophylaxis in total hip arthroplasty patients found aspirin to be as effective and safe as dalteparin. [76]

The EPCAT II (Extended Venous Thromboembolism Prophylaxis Comparing Rivaroxaban to Aspirin Following Total Hip and Knee Arthroplasty II) trial randomly assigned patients to receive either aspirin 81 mg/day or rivaroxaban 10 mg/day on postoperative day 6 after an initial 5 days of rivaroxaban 10 mg/day. [77] Patients who underwent knee arthroplasty continued prophylaxis for an additional 9 days, and those who underwent hip arthroplasty continued for an additional 30 days. All patients were followed for 90 days.

The trial showed aspirin to be noninferior to rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. [77] Eleven (0.64%) patients in the aspirin group developed symptomatic proximal DVT or PE during follow-up, compared with 12 (0.70%) in the rivaroxaban group. The combination of major bleeding and clinically relevant nonmajor bleeding occurred in 22 (1.29%) in the aspirin group and 17 (0.99%) in the rivaroxaban group; however, the rate of major bleeding alone was higher in the aspirin group (0.47%) than in the rivaroxaban group (0.29%).

In November 2015, the FDA approved dabigatran for prophylaxis of DVT and PE after hip replacement surgery. [78]

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