This study from the Pulmonary Embolism Prevention (PEP) Trial
Collaborative Group provides sound evidence for routinely considering
postoperative low-dose aspirin therapy as a prophylaxis against
both PE and DVT for patients who have had operative treatment for
hip fracture, total hip arthroplasty, or total knee replacement.
The conclusions of this study confirm a meta-analysis of about 8000
patients that also suggested that low-dose aspirin was an effective
thromboembolic prophylactic agent.
The PEP Trial was undertaken to confirm or refute the conflicting
data in the literature regarding the benefits of low-dose aspirin
as a prophylaxis against DVT and PE. In order to provide sufficient
statistical power, 13,356 hip fracture patients and 4088 total hip
and knee replacement patients (in New Zealand only) were randomized
to receive either low-dose aspirin or placebo. The use of low-dose aspirin
resulted in substantial reductions in the rates of symptomatic DVT,
venographically proven DVT, fatal PE, and combined PE and DVT. Those
patients treated with and without another thromboembolic prophylactic
agent, such as heparin, benefited from the low-dose aspirin regimen
throughout the 5-week treatment period.
The members of the PEP Trial Collaborative Group are to be congratulated
for asking an important question, developing a well designed protocol,
and answering the question by means of a multicenter study of sufficient
statistical power. Physicians may wish to offer their patients with
hip fracture low-dose aspirin therapy as a prophylaxis against both
DVT and PE.
Robert B. Bourne, M.D., F.R.C.S.(C)
London Health Sciences CentreUniversity of Western OntarioLondon,
Ontario, Canada