Aspirin Monotherapy Noninferior to Rivaroxaban Bridge After Arthroplasty

EPCAT III establishes that aspirin alone matches a 5-day rivaroxaban lead-in followed by aspirin for VTE prevention after elective hip or knee replacement, simplifying prophylaxis without a bleeding penalty.

aspirinrivaroxabanvenous thromboembolismVTE prophylaxistotal hip arthroplastytotal knee arthroplastyanticoagulationdirect oral anticoagulantnoninferiority trialEPCAT IIIorthopedic surgery Cardiology / Anticoagulation

Background Information

Aspirin matches rivaroxaban's efficacy in preventing post-surgical blood clots.

Anticoagulation strategy optimization following joint arthroplasty is crucial to prevent venous thromboembolism (VTE) while minimizing bleeding risks. The EPCAT III trial found aspirin alone was noninferior to rivaroxaban followed by aspirin for VTE prevention with similar bleeding rates. Aspirin monotherapy post-surgery may simplify thromboprophylaxis protocols without compromising safety or efficacy, but patient-specific risk factors should be considered. Aspirin alone is a viable alternative for thromboprophylaxis in joint arthroplasty.

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Authors: Shivakumar S, Matino D, Zukor D, Kahn SR, Vincent G, Mundi R, Vendittoli PA, Refaei M, Bohm E, Tanzer M, Pelet S, Richardson G, Powell J, Ikesaka R, Douketis J, Ward S, Kim P, Mann S, Pleasance S, Cormier J, Andreou P, Matheson K, Theriault C, West C, Anderson D, Gross PL, EPCAT III Trial Investigators

Citation: Shivakumar S, Matino D, Zukor D, et al. Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty. The New England journal of medicine. 2026. doi:10.1056/NEJMoa2603649

Article Links: PubMed · Journal / DOI

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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