From the Guidelines
Aspirin can be considered for DVT prophylaxis in certain clinical situations, but it is not the first-line option for most patients, as anticoagulants have been shown to be more effective in preventing recurrent VTE, as demonstrated in a study published in Chest in 2021 1. When considering aspirin for DVT prophylaxis, it is essential to weigh the benefits against the risks, including the risk of bleeding.
- Aspirin works by inhibiting platelet aggregation, which makes it less effective than anticoagulants for preventing venous thrombosis in higher-risk situations.
- The benefit of aspirin is its low cost, oral administration, and reduced bleeding risk compared to anticoagulants, but this comes at the expense of lower efficacy for DVT prevention in most clinical scenarios.
- A study published in Blood Advances in 2020 found that extending anticoagulant therapy beyond the primary treatment phase reduces the risk of recurrent VTE, but is associated with an increased risk for bleeding complications, and that anticoagulant therapy was more effective than aspirin in preventing recurrent VTE 1.
- Another study published in Blood Advances in 2018 suggested using aspirin rather than no VTE prophylaxis in people who are at substantially increased VTE risk and in whom LMWH or graduated compression stockings is not feasible, but this was a conditional recommendation with very low certainty in the evidence of effects 1. In general, anticoagulants such as low molecular weight heparin, unfractionated heparin, or direct oral anticoagulants are preferred over aspirin for DVT prophylaxis in most clinical scenarios, due to their higher efficacy in preventing recurrent VTE, as shown in the Chest study 1.
From the Research
Aspirin as DVT Prophylaxis
- The use of aspirin as a prophylactic agent for deep vein thrombosis (DVT) has been debated, with some studies suggesting its potential effectiveness 2, 3, 4.
- A study published in 2020 discussed the proposed mechanisms of aspirin in preventing venous thrombosis and reviewed the evidence for its use in primary and secondary prophylaxis of VTE 2.
- A systematic review and meta-analysis of randomized clinical trials found that the incidence of VTE with aspirin was not significantly different from other anticoagulants in patients undergoing major orthopedic surgeries 3.
- A retrospective case-control study suggested that preinjury aspirin use was associated with a reduced incidence of lower extremity DVT in trauma patients, particularly when used in combination with heparinoid prophylaxis 4.
- However, other studies have compared the effectiveness of different anticoagulants, such as low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs), in preventing VTE in major orthopedic surgery and acutely ill medical patients, without specifically focusing on aspirin 5, 6.
Comparison with Other Anticoagulants
- A network meta-analysis compared the effectiveness of selective factor Xa inhibitors and LMWHs in perioperative surgical thromboprophylaxis, but did not include aspirin as a comparator 5.
- A meta-analysis of phase III randomized clinical trials found that LMWH enoxaparin and DOACs had similar efficacy and safety profiles in preventing VTE in major orthopedic surgery and acutely ill medical patients 6.
- The available evidence suggests that aspirin may be considered as an alternative or adjunct to other anticoagulants for DVT prophylaxis in certain patient populations, but its use should be carefully evaluated and individualized 3, 4.