#336 ASA in TKA and THA Patients: Back to the future for VTE prophylaxis? (Free)

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- From three publicly funded, non-inferiority randomized controlled trials. Only symptomatic VTEs reported.
- After initial treatment with anti-coagulants:
- ASA versus LMWH:1 778 Canadian THA patients; received dalteparin for 10 days then randomized to dalteparin or ASA 81mg daily for another 28 days. Study terminated early due to recruitment challenges. At 3 months:
- Symptomatic VTE, major and relevant non-major bleeding: Not statistically different.
- ASA versus DOAC:2 3424 Canadian THA/TKA patients; received rivaroxaban for 5 days then randomized to rivaroxaban or ASA 81mg daily for 9 (knee) or 30 (hip) additional days. At 3 months:
- Symptomatic VTE, major and relevant non-major bleeding: Not statistically different.
- ASA versus LMWH immediately after surgery:3
- 9711 Australian TKA/THA patients randomized to ASA 100mg daily or enoxaparin 40mg/day for 14 (knee) or 35 (hip) days. Study stopped early for LMWH superiority. At 90 days:
- Symptomatic VTE: ASA 3.5% versus enoxaparin 1.8%, statistically different.
- Major bleeding, all-cause mortality: No difference.
- 9711 Australian TKA/THA patients randomized to ASA 100mg daily or enoxaparin 40mg/day for 14 (knee) or 35 (hip) days. Study stopped early for LMWH superiority. At 90 days:
- ASA versus LMWH:1 778 Canadian THA patients; received dalteparin for 10 days then randomized to dalteparin or ASA 81mg daily for another 28 days. Study terminated early due to recruitment challenges. At 3 months:
- Without prophylaxis, ~4% of arthroplasty patients will develop a symptomatic VTE.4
- Guidelines recommend anticoagulation for 14 (knee) and 35 (hip) days with one of LMWH, DOAC, Vitamin K antagonist, or ASA.4,5
- Medication Cost (30 days):6
- LMWH: $200-300
- DOAC: $50-100
- ASA: $5