From the Guidelines
Aspirin can be used for Deep Vein Thrombosis (DVT) prophylaxis, but it is not a recommended alternative to anticoagulation.
Key Points
- Aspirin has been shown to reduce the risk of recurrent VTE by about one-third, which is less effective than anticoagulants that can reduce the risk by more than 80% 1.
- The use of aspirin for DVT prophylaxis is suggested in patients who are stopping anticoagulant therapy and do not have a contraindication to aspirin, but this is a weak recommendation with low-certainty evidence 1.
- Aspirin may be considered in patients who decline extended anticoagulant therapy due to risk factors for bleeding or a lower than average risk of recurrence, but the net benefit of aspirin therapy is expected to be less than in trials that evaluated aspirin for extended treatment of VTE 1.
- The risk of bleeding with aspirin is similar to that of some anticoagulants, and the benefits of aspirin must be balanced against its risk of bleeding and inconvenience 1.
Important Considerations
- Aspirin is not a substitute for anticoagulant therapy in patients who want extended therapy, and anticoagulants are generally preferred for DVT prophylaxis due to their higher efficacy 1.
- The decision to use aspirin for DVT prophylaxis should be individualized and based on a patient's specific risk factors and medical history 1.
The FDA Drug Labels for aspirin (PO) do not address this question.
From the Research
Aspirin for Deep Vein Thrombosis Prophylaxis
- Aspirin has been shown to be effective in preventing deep vein thrombosis (DVT) in various studies 2, 3, 4, 5, 6
- A study published in 1986 found that aspirin reduced the incidence of phlebographic DVT in patients undergoing total hip replacement 2
- A systematic review and meta-analysis published in 2024 found that aspirin was as effective as direct oral anticoagulants for venous thromboembolism prophylaxis following primary total hip arthroplasty or total knee arthroplasty 3
- A retrospective case-control study published in 2016 found that preinjury aspirin use was associated with a reduced incidence of lower extremity DVT in trauma patients 4
- Reviews published in 2017 found that aspirin is an effective, inexpensive, and safe form of VTE prophylaxis following arthroplasty 5, 6
Efficacy and Safety of Aspirin
- Aspirin has been shown to have a good side effect profile and is cost-effective compared to anticoagulants 6
- The use of aspirin does not require routine blood tests and is unlikely to result in haematoma formation or persistent wound drainage 5
- Aspirin has been found to be effective in preventing DVT in patients without a major risk factor for VTE, such as previous VTE 5
Comparison with Other Anticoagulants
- A study published in 2024 found that aspirin was as effective as rivaroxaban for primary thromboprophylaxis post-THA and TKA, without increased incidence of complications 3
- Anticoagulants have been found to have a higher rate of complications, including bleeding and wound-oozing, compared to aspirin 6