Thromboprophylaxis after Extremity Fracture — Time for Aspirin?

This editorial discusses hospital-acquired venous thromboembolism (VTE) prevention in patients with traumatic limb and pelvic fractures, evaluating aspirin’s efficacy versus low-molecular-weight heparin (LMWH). Mechanical prophylaxis is often impractical due to injury location, making pharmacologic options essential. LMWH has been widely adopted for effectiveness and safety, but patient compliance issues and cost burden prompt reevaluation. A large multicenter trial (12,211 participants in the Major Extremity Trauma Research Consortium) compared aspirin (81 mg orally, twice daily) to LMWH (30 mg subcutaneously, twice daily). Mortality at 90 days was similar (0.78% aspirin vs. 0.73% LMWH), confirming noninferiority. Pulmonary embolism and bleeding rates were comparable, though deep vein thrombosis was slightly more frequent with aspirin (2.51% vs. 1.71%). The findings support aspirin as a viable, inexpensive prophylactic option, meriting guideline updates. The editorial cautions that further studies are needed to assess aspirin’s role in other surgical contexts and at-risk nonsurgical populations.

This editorial discusses hospital-acquired venous thromboembolism (VTE) prevention in patients with traumatic limb and pelvic fractures, evaluating aspirin’s efficacy versus low-molecular-weight heparin (LMWH). Mechanical prophylaxis is often impractical due to injury location, making pharmacologic options essential. LMWH has been widely adopted for effectiveness and safety, but patient compliance issues and cost burden prompt reevaluation. A large multicenter trial (12,211 participants in the Major Extremity Trauma Research Consortium) compared aspirin (81 mg orally, twice daily) to LMWH (30 mg subcutaneously, twice daily). Mortality at 90 days was similar (0.78% aspirin vs. 0.73% LMWH), confirming noninferiority. Pulmonary embolism and bleeding rates were comparable, though deep vein thrombosis was slightly more frequent with aspirin (2.51% vs. 1.71%). The findings support aspirin as a viable, inexpensive prophylactic option, meriting guideline updates. The editorial cautions that further studies are needed to assess aspirin’s role in other surgical contexts and at-risk nonsurgical populations.