From the Research
In most cases, additional DVT prophylaxis is not recommended for inpatients already on dual antiplatelet therapy (DAPT) with aspirin and plavix (clopidogrel). The combination of aspirin and plavix provides significant antithrombotic effect, and adding pharmacological DVT prophylaxis could substantially increase the risk of bleeding, as seen in studies such as 1. However, the decision should be individualized based on the patient's specific thrombotic and bleeding risks.
Key Considerations
- For patients at very high risk of VTE (e.g., recent major orthopedic surgery, active cancer), consider mechanical prophylaxis such as intermittent pneumatic compression devices instead of pharmacological prophylaxis, as suggested by studies like 2 and 3.
- If pharmacological prophylaxis is deemed necessary due to extremely high thrombotic risk, use a reduced dose of low molecular weight heparin and monitor closely for bleeding, as indicated by 4 and 5.
- Always reassess the need for DAPT and consider de-escalation to single antiplatelet therapy if appropriate, which may allow for safer addition of pharmacological DVT prophylaxis if needed.
Recent Evidence
The most recent study, 3, published in 2024, suggests that for high-risk knee arthroscopy patients, factor Xa inhibitors and LMWH drugs are appropriate for DVT prophylaxis, but this does not directly apply to patients on DAPT with aspirin and plavix.
Clinical Decision
Given the potential for increased bleeding risk with the addition of pharmacological DVT prophylaxis to DAPT, and considering the antithrombotic effect of aspirin and plavix, the use of additional DVT prophylaxis should be carefully considered on a case-by-case basis, prioritizing the patient's specific risks and the potential benefits and harms of such prophylaxis, as guided by studies such as 4, 1, 2, 5, 3.