The PEP trial is a multicenter RCT of 17,444 patients testing whether 160 mg daily aspirin (started preoperatively, continued 35 days) reduces VTE after hip fracture surgery or elective hip/knee arthroplasty compared to placebo. Patients could receive any concurrent thromboprophylaxis the treating physician deemed appropriate. The trial was powered to detect a one-third reduction in VTE, based on a prior meta-analysis of antiplatelet therapy.
Aspirin had long been dismissed for VTE prophylaxis because prior trials were individually underpowered. The PEP trial — with over 17,000 patients. Provided the definitive evidence needed to take antiplatelet thromboprophylaxis seriously in orthopedic surgery.
When your hip fracture patient is already on aspirin for cardiac disease, keep it going through the perioperative period. This trial shows no increase in fatal or disabling bleeding, and the VTE benefit is real and additive to heparin.
When managing post-discharge thromboprophylaxis after hip fracture or arthroplasty, remember that heparin is typically stopped at discharge while VTE risk persists for weeks. Aspirin's oral formulation makes it the practical agent to continue throughout this window.
The 58% reduction in fatal PE is the number worth memorizing. It translates to 4 lives saved per 1000 patients. A magnitude of benefit that justifies routine aspirin consideration across a wide range of high-risk surgical patients.
The PEP trial is a multicenter RCT of 17,444 patients testing whether 160 mg daily aspirin (started preoperatively, continued 35 days) reduces VTE after hip fracture surgery or elective hip/knee arthroplasty compared to placebo. Patients could receive any concurrent thromboprophylaxis the treating physician deemed appropriate. The trial was powered to detect a one-third reduction in VTE, based on a prior meta-analysis of antiplatelet therapy.
Aspirin had long been dismissed for VTE prophylaxis because prior trials were individually underpowered. The PEP trial — with over 17,000 patients. Provided the definitive evidence needed to take antiplatelet thromboprophylaxis seriously in orthopedic surgery.
When your hip fracture patient is already on aspirin for cardiac disease, keep it going through the perioperative period. This trial shows no increase in fatal or disabling bleeding, and the VTE benefit is real and additive to heparin.
When managing post-discharge thromboprophylaxis after hip fracture or arthroplasty, remember that heparin is typically stopped at discharge while VTE risk persists for weeks. Aspirin's oral formulation makes it the practical agent to continue throughout this window.
The 58% reduction in fatal PE is the number worth memorizing. It translates to 4 lives saved per 1000 patients. A magnitude of benefit that justifies routine aspirin consideration across a wide range of high-risk surgical patients.