Aspirin for DVT prophylaxis

Mark Crowther, MD, MSc, is a professor of medicine, chair of the Department of Medicine, and Leo Pharma Chair in Thromboembolism Research at McMaster University.

Can we use aspirin in the prophylaxis of deep vein thrombosis (DVT)?

Aspirin use is ubiquitous. Many, many patients take aspirin. There are many different indications for aspirin therapy. And aspirin does actually have a relatively limited role in the prevention of venous thromboembolism.

There are 2 randomized controlled trials, both of which suggest that if you have a patient who’s had a venous thromboembolism and you stop their oral anticoagulants, compared with placebo, aspirin will reduce the risk of recurrent venous thromboembolism.

In general, it is something that we consider. It is inferior to other forms of therapy, such as long-term full- or reduced-dose direct oral anticoagulants (DOACs), so it should only be used in patients in whom full- or reduced-dose DOACs are not indicated, but in a patient in whom you want to provide prophylaxis.

The most common circumstance that I would use it in is a patient who comes to the clinic. She or he has reached the end of their normal treatment protocol, but they wish to continue something. I might recommend aspirin for them because it’s relatively low risk, it’s very inexpensive, it’s easy to use, and patients are very familiar with it, so they are comfortable using it over the long term.