A Comparison between Enoxaparin and Aspirin in Preventing Deep Vein Thrombosis after Spine Surgery: A Randomized Clinical Trial

Document Type : RESEARCH PAPER


1 Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 3 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 4 Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran



Objectives: Deep Vein Thrombosis (DVT) is a significant medical concern characterized by the 
formation of blood clots within the venous system. Surgical procedures are known to increase the risk 
of DVT. While enoxaparin has proven to be highly effective in treating DVT, co ncerns about bleeding 
and accurate dosage regulation may restrict its application. Recent research has focused on aspirin's 
potential in preventing DVT after various surgeries. This study aimed to determine whether aspirin was 
as effective as enoxaparin in preventing DVT after spine surgery.
Methods: This randomized controlled trial enrolled study patients who underwent spine surgery at Shahid Kamyab 
Emergency Hospital in Mashhad, and had a Caprini score > 5, indicating a higher risk of DVT. In the control group, 
patients received subcutaneous injections of enoxaparin at a dosage of 40 mg, while the intervention group received 
oral aspirin tablets with a daily dosage of 81 mg. An experienced radiologist performed a Doppler ultrasound of the 
lower limbs' veins seven days after surgery to diagnose DVT. The outcomes of the two groups were then compared.
Results: A total of 100 patients participated in the clinical trial and were equally assigned to the aspirin and 
enoxaparin groups. Both groups were homogeneous regarding the basic and clinical characteristics. The incidence 
of postoperative DVT was 4.0% in the aspirin group and 10.0% in the enoxaparin group (p=0.092). The incidence 
of hemorrhage was 2.0% in the aspirin group and 4.0% in the enoxaparin group (p=0.610).
Conclusion: These findings indicate that aspirin may be a promising alternative to enoxaparin for DVT prevention 
after surgery, but additional research is essential to validate these results and further assess the benefits and risks 
associated with aspirin usage in this context.
 Level of evidence: II


Main Subjects

1. Brooks F, Lau S, Baddour E, Rao P, Bhagat S. 
Thromboprophylaxis in Spinal Surgery – Current UK Practice. 
J Spine. 2012; 1(121):2.
2. Al-Dujaili TM, Majer CN, Madhoun TE, Kassis SZ, Saleh AA. 
Deep venous thrombosis in spine surgery patients: incidence 
and hematoma formation. Int Surg.2012; 97(2):150-4. doi: 
3. Alvarado AM, Porto GBF, Wessell J, Buchholz AL, Arnold PM. 
Venous Thromboprophylaxis in Spine Surgery. Global Spine 
J.2020; 10(1 Suppl):65S-70S. doi: 
4. Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N. Deep venous 
thrombosis after posterior spinal surgery. Spine (Phila Pa 
1976). 2000; 25(22):2962-7. doi: 10.1097/00007632-
5. Fawi H, Saba K, Cunningham A, et al. Venous 
thromboembolism in adult elective spinal surgery: a tertiary 
center review of 2181 patients. Bone Joint J. 2017; 99-B 
(9):1204-1209. doi: 10.1302/0301-620X.99B9.BJJ-2016-
6. Rahbarian Yazdi F, Mehrad-Majd H, Gholami S, et al. A 
Comparison between Pre-Incisional and Intraoperative 
Lidocaine Infiltration on Post-Incisional Surgical Pain in 
Microdiscectomy Surgery: A Randomized Clinical Trial Study. 
Arch Bone Jt Surg. 2023; 11(10):635-640. doi: 
7. Cullari M, Aguer S, Lloyd R. Unexpected Bacteriological 
Finding Using Sonication in Revision Spine Surgery (Report of 
Two Cases). Arch Bone Jt Surg. 2023; 11(6):429-433. doi: 
8. Mashhadinejad, H, Sarabi E, Mashhadinezhad S, Ganjeifar B. 
Clinical Outcomes after Microdiscectomy for Recurrent 
Lumbar Disk Herniation: A Single-Center Study. Arch Bone Jt 
Surg. 2018; 6(5):397-401.
9. Tominaga H, Setoguchi T, Tanabe F, et al. Risk factors for 
venous thromboembolism after spine surgery. Medicine 
(Baltimore). 2015; 94(5):e466. doi: 
10. Bono CM, Watters III WC, Heggeness MH, et al. An evidencebased clinical guideline for the use of antithrombotic 
therapies in spine surgery. Spine J. 2009; 9(12):1046-51. doi: 
11. Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or 
rivaroxaban for VTE prophylaxis after hip or knee 
arthroplasty. N Engl J Med. 2018; 378(8):699-707. doi: 
12. Linkins L-A. Ground-Breaking Trial Shows Aspirin Is As 
Effective As Rivaroxaban Following Hip and Knee 
Arthroplasty. The Hematologist. 2018; 15(4). doi: 
10.1182/hem.V15.4.8714. 13. Azboy I, Barrack R, Thomas A, Haddad F, Parvizi J. Aspirin and the prevention of venous thromboembolism following 
total joint arthroplasty: commonly asked questions. Bone Joint J. 
2017; 99-B (11):1420-1430. doi: 10.1302/0301-
14. Kohli V, Sriramoju VB, Forrest T. A meta-analysis comparing 
aspirin versus rivaroxaban for venous thromboembolism 
prophylaxis in patients with knee or hip arthroplasty. Journal 
of the American College of Cardiology. 2019; 73(9S1):1933-
15. Arti H, Rouzbahani R. Comparing the Effectiveness Results of 
Heparin and Enoxaparin after Total Hip Arthroplasty. Journal 
of Isfahan Medical School. 2013; 31(231).
16. Michot M, Conen D, Holtz D, et al. Prevention of deep-vein 
thrombosis in ambulatory arthroscopic knee surgery: A 
randomized trial of prophylaxis with low–molecular weight 
heparin. Arthroscopy.2002; 18(3):257-63. doi: 
17. Vulcano E, Gesell M, Esposito A, Ma Y, Memtsoudis SG, 
Gonzalez Della Valle A. Aspirin for elective hip and knee 
arthroplasty: a multimodal thromboprophylaxis protocol. Int 
Orthop. 2012; 36(10):1995-2002. doi: 10.1007/s00264-012-
18. Kroegel C, Reissig A. Principle mechanisms underlying 
venous thromboembolism: epidemiology, risk factors, 
pathophysiology and pathogenesis. Respiration.2003; 
70(1):7-30. doi: 10.1159/000068427.
19. Jaureguito JW, Greenwald AE, Wilcox JF, Paulos LE, 
Rosenberg TD. The incidence of deep venous thrombosis 
after arthroscopic knee surgery. Am J Sports Med.1999; 
27(6):707-10. doi: 10.1177/03635465990270060401.