EPCAT III

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty.

Anderson DR, Dunbar M, Murnaghan J, et al. The New England journal of medicine 2018 · PMID 29466159 · doi:10.1056/nejmoa1712746

Question

After a short course of rivaroxaban, is extended aspirin as effective as continued rivaroxaban for VTE prevention after hip or knee replacement?

Design

Multicentre double-blind randomised non-inferiority trial in Canadian centres.

Patients

Adults undergoing elective total hip or knee arthroplasty who all received rivaroxaban until postoperative day 5.

Intervention

Switch to aspirin (to 35 days for hips, 14 days for knees)

Comparison

Continued rivaroxaban

Primary outcome

Symptomatic VTE at 90 days

Key result

Aspirin was non-inferior to rivaroxaban for symptomatic VTE, with low event rates in both groups. There was no significant difference in major or clinically relevant bleeding.

Limitations

All patients had five days of rivaroxaban first, so the result does not support aspirin alone from day one; low event rates limit precision.

Impact on practice

Supports the NICE NG89 option of a short anticoagulant course followed by extended aspirin after hip replacement.