Does aspirin (acetylsalicylic acid) work for deep vein thrombosis (DVT) prophylaxis in cancer patients?

From the Guidelines

Aspirin is not recommended as the primary agent for DVT prophylaxis in cancer patients, except in highly select cases such as patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone, where low-dose aspirin may be considered as an alternative to low-molecular-weight heparin (LMWH) 1. Cancer patients require more potent anticoagulation, typically with LMWHs like enoxaparin (40mg subcutaneously daily) or direct oral anticoagulants (DOACs) such as apixaban (2.5mg twice daily) or rivaroxaban (10mg daily). These medications are preferred because cancer creates a hypercoagulable state that significantly increases thrombosis risk, and aspirin's antiplatelet mechanism is insufficient to counteract this heightened risk. While aspirin has some antiplatelet effects that may help prevent arterial thrombosis, it has limited efficacy against venous thromboembolism, particularly in high-risk populations like cancer patients. For patients with active cancer, especially those receiving chemotherapy or who are hospitalized, proper DVT prophylaxis with LMWHs or DOACs should be initiated based on individual risk assessment, considering factors like cancer type, stage, mobility status, and bleeding risk. The duration of prophylaxis typically continues throughout active cancer treatment or until the thrombotic risk decreases. Some key points to consider include:

• The use of LMWH or fondaparinux for prophylaxis in medically-treated patients with cancer and reduced mobility 1
• The recommendation for primary pharmacological prophylaxis of VTE with LMWH or direct oral anticoagulants in ambulatory patients with locally advanced or metastatic pancreatic cancer treated with systemic anticancer therapy and who have a low risk of bleeding 1
• The use of LMWH once per day or low-dose unfractionated heparin three times per day to prevent postoperative VTE in patients with cancer, with pharmacological prophylaxis started 2–12 h preoperatively and continued for at least 7–10 days 1

From the Research

Aspirin for DVT Prophylaxis in Cancer Patients

• The use of aspirin for deep vein thrombosis (DVT) prophylaxis in cancer patients has been studied in several research papers 2, 3, 4, 5, 6.
• A study published in the Journal of cardiovascular pharmacology and therapeutics found that aspirin was associated with reduced rates of venous thromboembolism (VTE) in older patients with cancer 2.
• Another study published in the Journal of surgical oncology compared the efficacy of aspirin and compression devices with low-molecular-weight heparin and pneumatic compression devices for VTE prophylaxis in orthopedic oncology patients, and found no significant difference in DVT rate between the two groups 3.
• A systematic review published in The Cochrane database of systematic reviews compared the efficacy and safety of different anticoagulants for the initial treatment of VTE in people with cancer, and found that low molecular weight heparin (LMWH) may be superior to unfractionated heparin (UFH) in reducing mortality and VTE recurrence 4.
• Other studies have discussed the use of aspirin for VTE prophylaxis in various patient populations, including those undergoing total joint arthroplasty 5 and medical and surgical patients 6.
• The evidence suggests that aspirin may have a role in DVT prophylaxis in cancer patients, but the decision to use aspirin should be based on individual patient risk factors and considerations, and should be made in consultation with a healthcare professional.
• Aspirin has been shown to decrease VTE incidence and overall inhospital mortality without significantly increased bleeding in older patients with cancer 2.
• However, the use of aspirin for DVT prophylaxis in cancer patients requires further study to fully understand its efficacy and safety in this population.