Research
PEPPER trial finds aspirin did not match anticoagulants after joint replacement
In PEPPER, aspirin did not meet noninferiority criteria versus warfarin or rivaroxaban for the primary outcome after hip or knee replacement.
The randomized PEPPER trial found that aspirin did not prevent venous thromboembolism (VTE) as well as warfarin or rivaroxaban in patients undergoing elective hip or knee replacement, MedPage Today reported. The primary composite outcome was death from any cause or symptomatic VTE over 6 months after 30 days of preventive treatment.
In the primary per-protocol analysis, the outcome occurred in 1.26% of aspirin recipients, 1.23% of warfarin recipients and 0.94% of rivaroxaban recipients. Comparisons of aspirin with warfarin and rivaroxaban did not meet the trial's criterion for noninferiority, while the comparison between the anticoagulants did. The trial also assessed bleeding, reoperation for wound problems or myocardial infarction, and none of the reported comparisons met the criterion for noninferiority.
The trial randomly assigned patients at 34 centers in the U.S. and Canada to aspirin, warfarin or rivaroxaban for 30 days. The researchers said crossovers and difficulty staying on assigned treatment compromised the benefits of randomization.
