Renaissance of Aspirin for the Primary and Secondary Prevention of Venous Thromboembolism

Long-standing controversy has surrounded aspirin as an antithrombotic modality to prevent venous thromboembolism (VTE), particularly in the orthopedic surgery arena. New data are emerging on the use of aspirin for both primary VTE prevention and secondary prevention of recurrent VTE after an initial anticoagulation course. This review article will provide the history behind the controversy, information regarding recent or ongoing clinical trials of aspirin for primary VTE prevention in major orthopedic surgery, evidence for aspirin in secondary prevention of recurrent VTE, and suggestions for future research. Aspirin may be a reasonable option for VTE prevention in certain major orthopedic surgery patients. Additionally, investigation among non-orthopedic populations such as the acutely ill medical patient and the non-orthopedic surgery patient is encouraged to provide further safety and efficacy data.