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How Does Aspirin Compare to Pricey Anticoagulants?

Researchers analyzed 13 studies to find out how well can aspirin compare to standard anticoagulants for preventing post-surgical blood clots.

When people have knee or hip replacement surgery, they may face the danger of blood clot formation. Such clots can form in the large veins of the legs, break loose and end up in the lungs as pulmonary embolisms. If this happens, it is a life-threatening complication. That’s why doctors often prescribe anticoagulants following surgery. How does aspirin compare to other anticoagulants in this situation?

Aspirin vs Pricey Anticoagulants:

A new study compared pricey anticoagulants such as rivaroxaban or dabigatran to inexpensive aspirin (JAMA Internal Medicine, online Feb. 3, 2020). There were 13 randomized controlled trials in this meta-analysis and systematic review. More than 6,000 people participated in these trials.

The investigators analyzed the data for evidence of any deep vein thrombosis after surgery. Abbreviated DVT, deep vein thrombosis is the medical term for a dangerous blood clot. How well did aspirin compare in effectiveness and safety?

They found that:

“The effectiveness and safety of aspirin did not appear to have been statistically significantly different from other anticoagulants used for venous thromboembolism prophylaxis after total hip and knee replacement and hence remains an option for use.”

The authors call for larger studies to determine whether more expensive anticoagulants sold as Pradaxa or Xarelto are any safer or more effective than aspirin. What we know for sure is that they are more expensive.

Other Studies Compare Aspirin to Anticoagulants After Surgery:

In summary, this is not the first study to compare aspirin to other anticoagulants for preventing post-operative blood clots. Unfortunately, researchers have not devoted enough attention to the question of whether discontinuing low-dose aspirin before surgery increases risk. This is truly a serious dilemma, since staying on aspirin through surgery might increase the chance of excessive bleeding. 

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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  • Matharu GS et al, "Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: A systematic review and meta-analysis of randomized clinical trials." JAMA Internal Medicine, online Feb. 3, 2020. doi:10.1001/jamainternmed.2019.6108
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