A new study suggests that aspirin alone can prevent dangerous blood clots following hip or knee replacement surgery, thereby helping to reduce costs.
Published in the New England Journal of Medicine and led by Dr Sudeep Shivakumar from Dalhousie, the research involved more than 5,400 patients living in Canada.
Participants were randomly assigned to receive either aspirin or rivaroxaban, with the latter followed by aspirin – the standard practice in many healthcare settings.
Results showed similar outcomes in both groups: about 0.5% of patients in each group developed serious blood clots, suggesting that aspirin alone is as effective as the more complex regimen. Bleeding complications were also comparable, with no significant differences between groups.
During a 90-day follow-up, survival and event-free outcomes were nearly identical, supporting the conclusion that aspirin alone is ‘non-inferior’, or equally effective within accepted clinical boundaries.
The authors concluded: ‘After total hip and total knee arthroplasty, the use of aspirin alone was not inferior to a strategy of using rivaroxaban followed by aspirin for the prevention of symptomatic venous thromboembolism, with no clinically relevant difference in bleeding events.’
The study is the first large, double-blind trial to compare these strategies head-to-head, providing high-quality evidence at a time when surgical volumes are rising globally. The findings could make care delivery more efficient and cost-effective across health systems.
Current approaches to post-surgery care often rely on newer anticoagulants that can be costly and require monitoring, which may limit access in some settings.
Dr Shivakumar, an associate professor and head of the Division of Haematology in Dal's Faculty of Medicine, said: ‘We now have evidence that an aspirin-only strategy for the prevention of blood clots after hip and knee replacements is safe and effective, and hopefully this study can better inform patients and health care providers when caring for patients after joint replacements.’
