Patient-Oriented Evidence That Matters

Aspirin No Different Than Rivaroxaban for Prevention of VTE After TKA or THA


Am Fam Physician. 2018 Aug 15;98(4):248.

Clinical Question

Is aspirin as effective as rivaroxaban (Xarelto) for prevention of venous thromboembolism (VTE) after total hip arthroplasty (THA) or total knee arthroplasty (TKA)?

Bottom Line

Extended prophylaxis with low-dose aspirin is similar in efficacy to rivaroxaban for the prevention of symptomatic VTE following TKA or THA. Aspirin is cheap, widely available, and effective, making it a good alternative to the more costly direct oral anticoagulants. (Level of Evidence = 1b)


In this study, investigators tested the efficacy of aspirin (81 mg) compared with rivaroxaban (10 mg) for extended VTE prophylaxis following TKA or THA. All patients in the study initially received in-hospital prophylaxis with rivaroxaban, 10 mg daily for five days, following surgery. Patients randomized to the rivaroxaban group (n = 1,718) continued this treatment, whereas those randomized to the other group (n = 1,709) started aspirin, 81 mg daily. Additionally, patients taking preoperative aspirin (81 mg) were allowed to continue its use in the postoperative phase. Study treatment was continued for nine additional days in patients who underwent TKA and 30 additional days in patients who underwent THA. The two pills, rivaroxaban or aspirin, were administered in identical gelatin capsules. Patients in the two groups had similar baseline characteristics and were followed for 90 days. In the intention-to-treat analysis, low-dose aspirin was noninferior to rivaroxaban for the primary efficacy outcome of symptomatic proximal deep venous thrombosis or pulmonar y embolism (0.64% vs. 0.70%; P < .001 for noninferiority). For the primary safety outcome of major bleeding or clinically relevant nonmajor bleeding, there was no significant difference detected between the two groups (1.29% in aspirin group vs. 0.99% in rivaroxaban group; P = .43).

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Inpatient (any location) with outpatient follow-up

Reference: Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018;378(8):699–707.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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