Disease prevention guidelines aspirin and Venous Thromboemlism

August 2023

The purpose of this document is to keep a working list of international guidelines with information on aspirin and venous thromboemlism prevention.  The guidelines themselves should be read for further information.

UK GUIDELINES

Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism NICE

NICE guideline Published: 21 March 2018 Last updated: 13 August 2019 www.nice.org.uk/guidance/ng89

NICE guidelines state that aspirin can be considered as one of several options ( see full guideline for alternative options) for the following scenarios:

Pharmacological VTE prophylaxis for people with myeloma who are receiving chemotherapy with thalidomide, pomalidomide or lenalidomide with steroids (aspirin 75 mg or 150 mg off label)

VTE prophylaxis for people undergoing elective hip replacement surgery whose risk of VTE outweighs their risk of bleeding (LMWH for 10 days followed by aspirin (75 mg or 150 mg for a further 28 days off label)

VTE prophylaxis to people undergoing elective hip replacement surgery whose risk of VTE outweighs their risk of bleeding (LMWH for 10 days followed by aspirin 75 mg or 150 mg for a further 28 days off label)

They make the following recommendations for research

What is the cost and clinical effectiveness of aspirin prophylaxis for people with fragility fractures of the pelvis, hip or proximal femur?

Jenny, J. , Pabinger, I. & Samama, C. M. (2018). European guidelines on perioperative venous thromboembolism prophylaxis. European Journal of Anaesthesiology, 35 (2), 123-129. doi: 10.1097/EJA.0000000000000728

EUROPEAN GUIDELINES

European guidelines make the following recommendations concerning aspirin and VTE prophylaxis:

•  We recommend the use of aspirin as an option for venous thromboembolism (VTE) prevention after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1B).
•  We suggest the use of aspirin for VTE prevention after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (high-risk procedures) in patients without high VTE risk (Grade 2C).
•  We suggest the use of aspirin for VTE prevention after low-risk orthopaedic procedures in patients with a high VTE risk or other high-risk orthopaedic procedures in patients without a high VTE risk (Grade 2C).
•  We suggest the use of aspirin for VTE prevention after total hip arthroplasty, total knee arthroplasty and hip fracture surgery in patients with an increased bleeding risk (Grade 2C).
•  We suggest the use of aspirin for VTE prevention after total hip arthroplasty or total knee arthroplasty in a rapid recovery (fast-track) programme (Grade 2C).
•  We recommend combining aspirin with intermittent pneumatic compression (IPC) devices for VTE prevention after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C).
•  We recommend no pharmacological VTE prevention after low-risk orthopaedic procedures in patients without high VTE risk (e.g. knee arthroscopy) (Grade 1C).
•  No recommendation can be made concerning dose and duration of aspirin treatment and patient selection.
•  We do not recommend aspirin for thromboprophylaxis in general surgery (grade 1C). However, this type of prophylaxis could be interesting especially in low income countries (Grade 2C) and adequate large-scale trials with proper study designs should be carried out (Grade 1C)

David R. Anderson, Gian Paolo Morgano, Carole Bennett, Francesco Dentali, Charles W. Francis, David A. Garcia, Susan R. Kahn, Maryam Rahman, Anita Rajasekhar, Frederick B. Rogers, Maureen A. Smythe, Kari A. O. Tikkinen, Adolph J. Yates, Tejan Baldeh, Sara Balduzzi, Jan L. Brożek, Itziar Etxeandia- Ikobaltzeta, Herman Johal, Ignacio Neumann, Wojtek Wiercioch, Juan José Yepes-Nuñez, Holger J. Schünemann, Philipp Dahm; American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019; 3 (23): 3898–3944. doi: https://doi.org/10.1182/bloodadvances.2019000975

USA GUIDELINES

USA guidelines for VTE prevention in surgical patients make the following recommendations involving aspirin:

– In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH).