Could Aspirin Replace Rivaroxaban Post-Arthroplasty?

Rivaroxaban and aspirin yield similar results when used as prophylaxis for venous thromboembolism (VTE) following total hip or total knee arthroplasty, a new study showed.

For their study, the researchers assessed 3424 patients undergoing total hip (n = 1804) or total knee arthroplasty (n = 1620).
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All patients included in the study were treated with once-daily 10 mg rivaroxaban until postoperative day 5 and subsequently were randomly assigned to continue rivaroxaban or switch to 81 mg aspirin per day for an additional 9 days following total knee arthroplasty or an additional 30 days following total hip arthroplasty.

Follow-up lasted 90 days. During this time, patients were monitored for symptomatic VTE and bleeding complications.

A total of 11 (0.64%) aspirin-treated patients experienced VTE compared with 12 (0.70%) rivaroxaban-treated patients. In addition, 8 (0.47%) aspirin-treated patients vs 5 (0.29%) rivaroxaban-treated patients experienced major bleeding complications, while 22 (1.29%) aspirin-treated patients and 17 (0.99%) rivaroxaban-treated patients experienced clinically important bleeding.

“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,” the researchers concluded.

—Christina Vogt

Reference:

Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty [Published online February 22, 2018]. N Eng J Med. doi:10.1056/NEJMoa1712746.