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Last but not least was this much-discussed paper in The New England Journal last May 2012 looking at aspirin for the prevention of the recurrence of VTE.[16] This was an interesting and well designed study that looked at those individuals with a first unprovoked VTE who received a full course of anticoagulation treatment from 6 months all the way out to 18 months and were then randomized to aspirin versus nothing for 2 more years. It is important to remember placebo here means that the patient was literally taken off and was not taking any antiplatelet or anticoagulant therapy.
As seen in the Figure, there was a benefit with aspirin, with a decrease in VTE recurrence of 6.6% versus 11.2%, a 42% reduction with aspirin compared to taking nothing. And there was only one major bleed in each group, although the mean age was 62 year, ie, a younger patient population.
So how should physicians think of translating these aspirin results into clinical practice? The first point must be that if the active group at been on warfarin, LMWH – or certainly rivaroxaban, dabigatran, or apixaban – then we can be fairly confident that the VTE recurrence rate would have been less than 6.6%. As a result, it’s not clear what patient population would warrant being treated with aspirin as opposed to one of the newer anticoagulants or even with well-controlled warfarin, but this study does serve to show healthcare providers what they are giving their patients when they decide to use aspirin instead of one of the anticoagulants. Hylek E. Am J Med 2013; published on-line at http://education.amjmed.com/00000.
[16] Becattini C, Agnelli G, Schenone A, et al; WARFASA Investigators. Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med. 2012;366:1959-1967.