X-ray illustration of hip replacement.

New Editorial Continues the Conversation on VTE Prophylaxis in Joint Arthroplasty

A new editorial offers additional perspective on a recent study of venous thromboembolism (VTE) prophylaxis in joint arthroplasty. The editorial appears in both JBJS and The Journal of Arthroplasty 

Low-Molecular-Weight Heparin Is Superior to Aspirin in the Prevention of Thromboembolic Disease: Or Is It? by Javad Parvizi, MD, FRCS; David E. DeMik, MD, PharmD; Michael Dunbar, MD, FRCSC, PhD; William J. Hozack, MD; Michael A. Mont, MD; and Paul F. Lachiewicz, MD. 

The editorial discusses a recent study in JAMA entitled, “Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty. The CRISTAL Randomized Trial”1. This prospective, randomized, crossover, registry-nested trial included patients from 31 centers in Australia. The study investigators found that the incidence of symptomatic VTE was significantly higher in patients who received aspirin (3.45%) compared with enoxaparin (1.82%).  

While commending the investigators for their work on this large trial, the editorial authors enumerate methodological shortcomings for consideration, noting that the study findings “are unlikely to impact the popularity of aspirin as the main modality for VTE prophylaxis.”  

The widely embraced use of aspirin as the main modality in total joint arthroplasty is further discussed.  

Read the full editorial at JBJS.org. 


  1. Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, Cashman K, Ackerman I, Bastiras D, Brighton R, Burns AWR, Chong BH, Clavisi O, Cripps M, Dekkers M, de Steiger R, Dixon M, Ellis A, Griffith EC, Hale D, Hansen A, Harris A, Hau R, Horsley M, James D, Khorshid O, Kuo L, Lewis P, Lieu D, Lorimer M, MacDessi S, McCombe P, McDougall C, Mulford J, Naylor JM, Page RS, Radovanovic J, Solomon M, Sorial R, Summersell P, Tran P, Walter WL, Webb S, Wilson C, Wysocki D, Harris IA; CRISTAL Study Group. Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial. JAMA. 2022 Aug 23;328(8):719-27. 

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