Table 1.
Summary of clinical practice guidelines involving the use of aspirin for the pharmacologic prophylaxis of VTE
| Society/Year VTE indication | Recommendation |
|---|---|
| ACCP24/2016 | |
| Secondary prophylaxis | In patients with an unprovoked proximal DVT or PE who are stopping anticoagulant therapy and do not have a contraindication to aspirin, we suggest aspirin over no aspirin to prevent recurrent VTE |
| AAOS43/2012 | |
| Elective hip or knee arthroplasty | We suggest the use of pharmacologic agents and/or mechanical compressive devices for the prevention of VTE in patients undergoing elective hip or knee arthroplasty, and who are not at elevated risk beyond that of the surgery itself for VTE or bleeding |
| ASH44/2019 | |
| THA or TKA | The ASH guideline panel suggests using aspirin (ASA) or anticoagulants |
| When anticoagulants are used, the panel suggests using DOACs over LMWH | |
| The panel suggests using any of the DOACs approved for use | |
| If a DOAC is not used, the panel suggests using LMWH rather than warfarin and recommends LMWH rather than UFH | |
| ESA45/2018 | |
| Hip fracture, hip arthroplasty, or knee arthroplasty | We recommend using aspirin, considering that it may be less effective than or as effective as LMWH for prevention of DVT and PE after THA, TKA, and hip-fracture surgery |
| Aspirin may be associated with less bleeding after THA, TKA, and hip-fracture surgery than other pharmacological agents | |
| General orthopedic procedures | Aspirin may be less effective than or as effective as LMWHs for prevention of DVT and PE after other orthopedic procedures |
| General surgery | We do not recommend aspirin as thromboprophylaxis in general surgery; however, this type of prophylaxis could be interesting especially in low-income countries and adequate large-scale trials with proper study designs should be carried out |
| NICE46/2018 | |
| Hip arthroplasty | Offer VTE prophylaxis to people undergoing elective hip-replacement surgery whose risk of VTE outweighs their risk of bleeding |
| Choose any 1 of: LMWH (for 10 d) followed by aspirin (75 or 150 mg) for a further 28 d; LMWH (for 28 d) combined with antiembolism stockings (until discharge); rivaroxaban | |
| Knee arthroplasty | Offer VTE prophylaxis to people undergoing elective knee-replacement surgery whose VTE risk outweighs their risk of bleeding |
| Choose any 1 of: aspirin (75 or 150 mg) for 14 d; LMWH (for 14 d) combined with antiembolism stockings (until discharge); rivaroxaban | |
| Multiple myeloma patients on immunomodulator therapy | Consider pharmacological VTE prophylaxis for people with myeloma who are receiving chemotherapy with thalidomide, pomalidomide, or lenalidomide with steroids |
| Choose either: aspirin (75 or 150 mg) or LMWH | |
| SIGN47/2010 | |
| General surgical patient | Aspirin is not recommended as the sole pharmacological agent for VTE prophylaxis in surgical patients, as other available agents are more effective |
| Orthopedic surgical patient | As other agents are more effective for prevention of DVT, aspirin is not recommended as the sole pharmacological agent for VTE prophylaxis in orthopedic patients |
| Medical patient | When the assessment of risk favors use of thromboprophylaxis, UFH, LMWH, or fondaparinux should be administered |
| Aspirin is not recommended as the sole pharmacological agent for VTE prophylaxis in medical patients |
AACP, American College of Chest Physicians; AAOS, American Academy of Orthopaedic Surgeons; ASA, acetylsalicylic acid; ASH, American Society of Hematology; DOAC, direct oral anticoagulant; ESA, European Society of Anaesthesiology; NICE, National Institute for Health and Clinical Excellence; SIGN, Scottish Intercollegiate Guidelines Network; UFH, unfractionated heparin.