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.
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