Is Aspirin used for Deep Vein Thrombosis (DVT) prophylaxis?

From the Guidelines

Aspirin is not a first-line treatment for Deep Vein Thrombosis (DVT) prophylaxis, but it may be considered for patients who cannot or will not take anticoagulants.

Key Points

• The use of aspirin for DVT prophylaxis is supported by studies such as the WARFASA and ASPIRE trials, which showed a decrease in recurrent VTE with aspirin therapy 1.
• However, anticoagulant therapy is generally more effective than aspirin in preventing recurrent VTE, with a reduction in risk of over 80% compared to aspirin's reduction of about one-third 1.
• The decision to use aspirin for DVT prophylaxis should be individualized, taking into account the patient's risk of recurrent thrombosis and bleeding, as well as their personal preferences and values 1.
• Aspirin may be considered for patients who are at high risk of bleeding or who have a low risk of recurrence, but the benefits and risks must be carefully weighed 1.
• The dose of aspirin used for DVT prophylaxis is typically 100 mg daily, as used in the WARFASA and ASPIRE trials 1.

Benefits and Risks

• The benefits of aspirin for DVT prophylaxis include a reduction in recurrent VTE and possibly a small reduction in arterial thrombosis risk 1.
• The risks of aspirin therapy include an increased risk of bleeding, with an estimated 3-4 more events per 1,000 cases per year 1.
• The certainty of the evidence for aspirin's effectiveness and safety is moderate, due to the limitations of the available studies 1.

From the Research

Aspirin for Deep Vein Thrombosis (DVT) Prophylaxis

• Aspirin is used as a prophylactic measure for Deep Vein Thrombosis (DVT) in various clinical settings, including orthopedic surgery and trauma patients 2, 3, 4, 5, 6.
• Studies have shown that aspirin is effective in preventing VTE, including DVT, in patients undergoing hip or knee arthroplasty 2, 3, 5.
• A systematic review and meta-analysis found that aspirin was associated with a non-significantly reduced VTE events compared with other thromboprophylactic methods, but was associated with a significant reduction of VTE compared with placebo 3.
• Another study found 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.
• Aspirin has also been shown to be an effective option for VTE prophylaxis in patients with femoral neck fracture who undergo hip arthroplasty, with a lower VTE rate compared with other anticoagulants 5.
• A systematic review and meta-analysis found that aspirin demonstrates similar protective effects on prevention of VTE compared to other agents and may have significant protective effects on overall mortality following surgical intervention for hip fractures 6.

Clinical Settings

• Orthopedic surgery: Aspirin is used as a prophylactic measure for DVT in patients undergoing hip or knee arthroplasty 2, 3, 5.
• Trauma patients: Aspirin may be used as an added prophylaxis for DVT in trauma patients, particularly when used in combination with heparinoid prophylaxis 4.
• Hip fracture surgery: Aspirin is used as a prophylactic measure for VTE, including DVT, in patients undergoing hip fracture surgery 6.

Efficacy and Safety

• Aspirin has been shown to be effective in preventing VTE, including DVT, in various clinical settings 2, 3, 4, 5, 6.
• Aspirin is generally considered safe, with no significant increase in bleeding complications compared with other anticoagulants 2, 3, 5.
• However, the current evidence concerning the use of aspirin for DVT prophylaxis is less than robust, with more than half of the studied outcomes considered statistically fragile 6.