The People's Perspective on Medicine

Is Aspirin Cost-Effective Blood Clot Prevention?

Some clinical trials have found that aspirin is just as good as expensive anticoagulants for post-surgical blood clot prevention. And much cheaper!
Single baby aspirin may be helpful to cardiac health

Blood clots can be useful if you cut yourself. That’s how the body stops the wound from bleeding. In many circumstances, however, blood clots are undesirable. Doctors prescribe expensive anticoagulants for blood clot prevention after surgery as well as for irregular heart rhythms. Could simple aspirin work almost as well in some situations? That is what one reader suggests.

Aspirin Instead of Lovenox for Blood Clot Prevention:

Q. Recently my wife had ‘revision’ hip surgery. The orthopedic surgeon prescribed a single 325 mg aspirin tablet a day.

In a previous episode, she was prescribed Lovenox, an injectable drug for blood clot prevention. The Lovenox cost $750, whereas the aspirin was just pocket change. Maybe doctors are starting to move away from high-cost drugs.

Aspirin vs Anticoagulants:

A. After joint replacement surgery, doctors often prescribe an anticoagulant for blood clot prevention. This post-surgical complication can be life threatening. Doctors may assume that the newer, fancier oral anticoagulants are better than a drug that has been around for more than a century. However, a study in JAMA Surgery (Jan. 2019) demonstrated that aspirin was comparable to far more expensive anticoagulants. 

In addition, a new study in Orthopedic Surgery (Oct. 2019) compared aspirin to rivaroxaban (Xarelto) after hip fracture surgery. In this trial, the investigators administered enoxaparin (Lovenox) to everyone for five days after surgery. After that initial time, the volunteers took aspirin or Xarelto for an additional three weeks, according to their random assignment.

The surgeons concluded that

“Aspirin may be an effective, safe, convenient, and cheap alternative for extended prophylaxis after hip fracture surgery.”

Of course no one should independently substitute aspirin for a prescribed anticoagulant. That is a decision that needs to be make collaboratively with a physician. There are situations where one of the new anticoagulants is the best choice for clot prevention.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
    Key Aspirin Information
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    Key Aspirin Information
    Citations
    • Hood BR et al, "Association of aspirin with prevention of venous thromboembolism in patients after total knee arthroplasty compared with other anticoagulants: A noninferiority analysis." JAMA Surgery, Jan. 2019. doi:10.1001/jamasurg.2018.3858
    • Huang Q et al, "Comparison of the efficacy and safety of aspirin and rivaroxaban following enoxaparin treatment for prevention of venous thromboembolism after hip fracture surgery." Orthopedic Surgery, Oct. 2019. DOI: 10.1111/os.12542
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    I am 85 years old and have AFIB. I was put on Xarelto 8 years ago. I was always getting terrible bruising and bleeding. I had light flutters every morning, took 15 mg every night. I am very active and basically in good health. I take Diltiazem mg 120 every morning before breakfast, plus vitamin D3 daily.

    At my last visit my cardiologist said my blood pressure is perfect, my heart is strong, my electric cardio is perfect, and he said “I don’t think you need to take Xarelto. Just start on low-dose aspirin every day.” I have been off Xarelto almost 2 months. I still get mild bruising but I feel much better. I walk 2 miles every day and am still playing golf with my younger friends.

    I’m a 79 yr-old female who had a successful R atherectomy (angiogram procedure) in August because of a plaque-blocked femoral artery in my R leg. I was put on Plavix after the procedure. But I have GERD and have to take omeprazole daily, and the two medications interact (all PPOs are contraindicated while on Plavix). So I had to switch to an H2 blocker, which did not work for me at all and caused stomach issues as well. Because of this, after 6 wks of being on Plavix, my cardiovascular surgeon said I could go off Plavix and back on omeprazole IF I promised to take a 325mg aspirin each day, which I do faithfully. So far, so good, and I’m not experiencing bruising or bleeding issues now, which is definitely a big plus! Thank the Lord for good old-fashioned aspirin.

    As with almost all of the ‘natural’ alternatives for ‘big pharma’s’ solutions, there’s very little $ to do comparisons.
    I understood several years ago that there IS some research about aspirin’s anti-cancer benefits for the total digestive system. So with the unpredictability of all anti-coagulants, I’ll keep on a 1/2, inexpensive, (no talc added) aspirin per day as was prescribed after my knee replacement! Thanks for caring, Graedons!

    What is most important with Aspirin is to take it with food, or a full glass of liquid, as we were taught in back in the day! Aspirin is all I have ever used in 78yrs.

    My hip surgeon in Naples Fl uses aspirin post surgery and provides a copy of the research in the info package he supplies to patients. As he has had no serious complications in the past 9 years I believe him.

    Your last paragraph is important — no one should switch anticoagulants independently. My mother switched from coumadin to aspirin for her atrial fibrillation, and she then had a stroke and will never recover. Although she WAS under a doctor’s care and the risks of switching were weighed, in this case, it was the wrong decision.

    After one incident of atrial flutter I was put on dilitazem and xarelto. Have taken low-dose aspirin for years. Got off xeralto as soon as I could. Too much risk, in my opinion.

    How about those who can’t take aspirin or related products? I developed severe gastritis after taking naproxen post-surgery for a ruptured appendix. I’m now extremely careful that I don’t take aspirin or anything related to it. Would you know of any possible alternatives? Thank you.

    I had a knee replacement done in 2014 (age 71) and was sent home on aspirin therapy. I developed a blood clot behind the knee within 4 days. I was then put on Lovenox for three weeks, then warfarin for three months. It was a very painful experience, to say the least! My surgeon just said that I had “failed aspirin therapy.” The doctor who treated me for the blood clot had a very low opinion of using aspirin therapy after this type of surgery. I had the other knee replaced two months ago and was put on Xarelto for two weeks and had no problems this time. Be careful! A blood clot is very dangerous and extremely painful.

    Question: If there is a bleeding episode with Xarelto is it reversible? How about on aspirin? I have a friend who recently had to have her colon removed because of bleeding from one of the newer anticoagulants she was taking to prevent stroke. She is in her 80s. Hard time in life to adjust to a colonostomy. This has prompted my question.

    Last year (2018) FDA approved Andexxa to reverse bleeding due to Xarelto:
    https://www.dicardiology.com/article/fda-clears-first-reversal-agent-rivaroxaban-apixaban-anticoagulants

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