From the Guidelines
Aspirin is recommended at a dose of 100 mg daily for DVT prophylaxis, as supported by the most recent and highest quality study 1. This dose has been shown to decrease the risk of recurrent VTE without increasing the risk of clinically relevant bleeding. The use of aspirin for DVT prophylaxis is based on its antiplatelet effect, which prevents platelet aggregation and reduces clot formation. Some key points to consider when using aspirin for DVT prophylaxis include:
- The duration of prophylaxis varies based on the clinical situation, ranging from 10-14 days for surgical patients to 35 days for those undergoing hip or knee replacement.
- Aspirin may be less effective than other anticoagulants like low molecular weight heparin or direct oral anticoagulants for high-risk patients.
- Patients should take aspirin with food to reduce stomach irritation and should be monitored for signs of bleeding or gastrointestinal discomfort during treatment. It's also important to note that the American Society of Hematology guideline panel has provided a conditional recommendation supporting the use of anticoagulation over aspirin for secondary prevention of VTE 1. However, for patients who are going to discontinue anticoagulant therapy after completion of the primary treatment phase, the role of aspirin can be considered but needs to be individualized. In contrast to earlier studies, such as the American College of Chest Physicians evidence-based clinical practice guidelines 1, which suggested a dose of 160 mg daily, the more recent study 1 supports the use of a lower dose of 100 mg daily. Overall, the use of aspirin for DVT prophylaxis should be tailored to the individual patient's risk factors and clinical situation.
From the Research
Aspirin Dose for DVT Prophylaxis
- The optimal aspirin dose for deep vein thrombosis (DVT) prophylaxis is not universally established, but several studies provide insight into its efficacy and safety 2, 3, 4, 5.
- A study published in 2021 found that 75 mg of aspirin daily is safe for VTE prophylaxis after total hip or knee arthroplasty, with no significant difference in complication rates compared to low-molecular-weight heparin (LMWH) 2.
- Another study from 2016 suggested that preinjury aspirin use is associated with a reduced incidence of lower extremity DVT in trauma patients, with an odds ratio of 0.17 (95% confidence interval, 0.04-0.68; p = 0.012) in multivariate analysis 3.
- A 2010 study compared the efficacy of aspirin and pneumatic compression devices (PCD) to LMWH and PCD in patients undergoing orthopedic procedures for musculoskeletal neoplasms, finding no significant difference in DVT rate between the two groups 4.
- A randomized controlled trial published in 2021 found that 100 mg aspirin twice daily has comparable efficacy to rivaroxaban for VTE prophylaxis following primary total hip arthroplasty, with no significant difference in symptomatic VTE incidence, DVT rate, or total blood loss 5.
Key Findings
- Aspirin doses of 75 mg daily and 100 mg twice daily have been studied for DVT prophylaxis, with varying results 2, 5.
- Aspirin may be a suitable alternative to LMWH for DVT prophylaxis in certain patient populations, such as those undergoing total hip or knee arthroplasty or trauma patients 2, 3.
- Further research is needed to establish the optimal aspirin dose and duration for DVT prophylaxis, as well as to compare its efficacy and safety to other anticoagulants 6, 5.