From the Guidelines
Aspirin can be used as DVT prophylaxis, but it is not the first-line option for most patients, and its use should be individualized based on the patient's risk factors and clinical scenario. According to the most recent and highest quality study, 1, aspirin is not a recommended alternative to anticoagulation for DVT prophylaxis, as the net benefit of extended anticoagulant therapy is substantially greater than the benefits of extended aspirin therapy. However, for patients who are at substantially increased VTE risk and in whom low molecular weight heparin (LMWH) or graduated compression stockings is not feasible, aspirin may be considered as an alternative, as suggested by the American Society of Hematology 2018 guidelines 1.
When using aspirin for DVT prophylaxis, the dose should be 81-325 mg daily, and it should be combined with early mobilization and mechanical methods like compression stockings when possible. Patients should be monitored for gastrointestinal side effects and bleeding risks, particularly those with a history of peptic ulcer disease or concurrent use of other medications that increase bleeding risk. The benefits of aspirin in preventing recurrent VTE should be balanced against its risk of bleeding and inconvenience, as noted in the study 1.
In certain clinical scenarios, such as extended prophylaxis after completing standard anticoagulation in selected patients, aspirin may be considered as an option, but its use should be guided by the individual patient's risk factors and clinical scenario, as suggested by the American Society of Hematology 2020 guidelines 1.
Key points to consider when using aspirin for DVT prophylaxis include:
- Aspirin is not the first-line option for most patients
- Aspirin may be considered for patients at substantially increased VTE risk and in whom LMWH or graduated compression stockings is not feasible
- The dose of aspirin should be 81-325 mg daily
- Aspirin should be combined with early mobilization and mechanical methods like compression stockings when possible
- Patients should be monitored for gastrointestinal side effects and bleeding risks.
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.