Prevention of Venous Thromboembolism after Total Hip or Knee Replacement.

In elective total hip or knee arthroplasty, aspirin (81 mg twice daily) was not noninferior to rivaroxaban or warfarin for death or symptomatic VTE at 6 months.

• Why it matters: Prior trials comparing aspirin with anticoagulants for VTE prevention after arthroplasty have produced conflicting findings, leaving uncertainty about effectiveness and bleeding risk.
• What they did: In a comparative-effectiveness noninferiority trial of 18,883 randomized participants, patients received aspirin, warfarin (INR target 2.0), or rivaroxaban for 30 days, with blinded assessment through 6 months.
• The result: Primary effectiveness events occurred in 1.26% with aspirin vs 0.94% with rivaroxaban and 1.23% with warfarin, and aspirin was not noninferior; safety events were also not noninferior for warfarin or rivaroxaban versus aspirin.

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