PREVENTion of Clot in Orthopaedic Trauma
PREVENTion of Clot in Orthopaedic Trauma
The purpose of this study is to compare aspirin versus low-molecular weight heparin (LMWH)
 (Enoxaparin) as a thromboprophylaxis in patients who sustain a fracture.
Patients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism
 (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend
 low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients.
 However, emerging literature in total joint arthroplasty patients suggests the potential
 clinical benefits of VTE prophylaxis with aspirin. This trial aims to determine if aspirin is
 non-inferior to LMWH for thromboprophylaxis in fracture patients.
Inclusion Criteria:

 • Patients who have a planned operative or non-operative pelvis or acetabular fracture, or
 any operative extremity fracture proximal to the metatarsals or carpals.

 Exclusion Criteria:

 -  Patients who present to the hospital more than 48 hours post injury

 -  Patients who received more than 2 doses of LMWH or aspirin for initial VTE prophylaxis

 -  Patients on long term blood thinners (other than low-dose aspirin or platelet
 inhibitors such as Plavix or Aggrenox)

 -  Patients who have had a VTE within the last 6 months

 -  Patients on therapeutic (as opposed to prophylactic) blood thinners for an acute issue
 at the time of admission

 -  Patients who have a newly diagnosed indication for therapeutic blood thinners (for
 example vascular injury) that will require therapeutic anticoagulation for more than
 one week

 -  Patients who cannot receive either of the study medications due to an allergy (history
 of heparin induced thrombocytopenia, allergy to aspirin, or NSAIDs) or other medical
 contraindication to blood thinners

 -  Patients who are on higher dose aspirin (>81 mg once a day or higher) for medical
 reasons or who will be treated with higher dose aspirin

 -  Patients with underlying chronic clotting disorders (i.e. Factor V Leiden,
 hyperhomocysteinemia, Protein C and S deficiency) that require full dose
 anticoagulation or are a contraindication to venous thromboembolism chemoprophylaxis

 -  Patients with end stage renal disease or impaired creatinine clearance <30 ml/min at
 time of randomization(note: creatinine clearance does not need to be documented if
 prescribing physician would order medication without test as SOC)

 -  Pregnant or lactating patients

 -  Patients contraindicated for any reason for either medicine

 -  Prisoners

 -  Patients who do not speak either English or Spanish

 -  Patients may be excluded for other reasons at the discretion of the treating
 physician; the reason for exclusion must be documented on the screening form

 -  Patients who have a known COVID-19 diagnosis prior to fracture treatment or within 3
 months of the index fracture.