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 Use for Deep Vein Thrombosis (DVT) Prophylaxis

• Aspirin has been studied as a potential prophylaxis for DVT in various patient populations, including those undergoing orthopedic surgery and those with trauma or femoral neck fractures.
• A systematic review and meta-analysis of randomized controlled trials found that aspirin was as effective as rivaroxaban for primary thromboprophylaxis post-total hip arthroplasty and total knee arthroplasty, without increased incidence of complications 2.
• A retrospective case-control study found that preinjury aspirin use was 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 the most complete model 3.
• A multicenter study found that aspirin was an effective prophylaxis for VTE in ambulatory patients with femoral neck fracture undergoing hip arthroplasty, with a VTE rate of 1.98% compared to 6.7% for patients who received other anticoagulants (p < 0.001) 4.
• A systematic review and meta-analysis found that aspirin demonstrated 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 5.
• However, a retrospective study in Japan found that aspirin was not effective for preventing VTE in patients with proximal femoral fractures, with no statistically significant difference in DVT incidence between the aspirin and control groups (OR: 0.81; 95%CI: 0.49- 1.36; p = 0.44) 6.

Key Findings

• Aspirin may be an effective prophylaxis for DVT in certain patient populations, such as those undergoing orthopedic surgery or with trauma or femoral neck fractures.
• However, the evidence is not consistent across all studies, and more research is needed to determine the optimal dosing regimen and long-term efficacy of aspirin for DVT prophylaxis.
• Aspirin may have a protective effect on overall mortality following surgical intervention for hip fractures, but this finding needs to be confirmed by further studies 2, 3, 4, 5.