Is aspirin alone enough to prevent venous thromboembolism after total hip or knee arthroplasty?

In this episode of CLOT Conversations, Dr. Jameel Abdulrehman speaks with Dr. Sudeep Shivakumar, lead author of the EPCAT III trial, recently published in the New England Journal of Medicine.

EPCAT III randomized more than 5,400 patients undergoing hip or knee arthroplasty to receive aspirin alone or rivaroxaban for five days followed by aspirin. Dr. Shivakumar discusses the study's findings, including the low rates of symptomatic VTE observed in both groups, bleeding outcomes, the significance of distal DVT, and how EPCAT III builds on the earlier EPCAT trials.

They also explore whether modern surgical care has changed the baseline risk of VTE following arthroplasty and which higher-risk patients may still warrant an anticoagulant-based approach.

A practical discussion about translating an important Canadian clinical trial into individualized thromboprophylaxis decisions.

Reference:

Shivakumar, Sudeep, et al. "Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty." New England Journal of Medicine (2026). https://www.nejm.org/doi/abs/10.1056/NEJMoa2603649

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