Prevention of Venous Thromboembolism after Total Hip or Knee Replacement.

What was studied

This trial tested ways to stop blood clots after joint surgery. People were having a planned hip or knee replacement. By chance, each person got aspirin, warfarin, or rivaroxaban for 30 days. The team checked for death or clots that caused symptoms. They also checked for bleeding, a new wound surgery, or a heart attack. People were followed for 6 months. The aim was to see if aspirin works about as well as the other drugs.

What they found

In all, 18,883 people joined the trial. The main analysis had 15,317 of them. Death or a clot with symptoms hit 77 of 6090 people on aspirin. It hit 52 of 4231 on warfarin and 47 of 4996 on rivaroxaban. Safety problems hit 177 on aspirin, 142 on warfarin and 174 on rivaroxaban. The team could not rule out that aspirin was worse for clots. They also could not rule out more safety problems with the other drugs.

What it means for patients

The authors say aspirin did not pass their test for being as good. This test was about death or clots with symptoms. They also say the other drugs did not pass their safety test. That safety test was set against aspirin.

Why it is not certain yet

Not everyone who joined was in the main analysis. A second analysis of all people gave similar results. People were followed for 6 months. The abstract does not give results for hip or knee surgery on its own. Failing to show a drug is as good does not prove it is worse.

Source

Prevention of Venous Thromboembolism after Total Hip or Knee Replacement.

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