PREVENTion of Clot in Orthopaedic Trauma

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.
• Patients at increased risk of blood clot(s) from their orthopaedic injury(ies) and will receive prophylactic blood thinner regimen per standard of care.
• Patients 18 years or older.

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
• Prisoners
• Patients who do not speak either English or Spanish
• Patients who are likely to have severe problems maintaining follow-up
• Patients, based upon the clinical judgment of the treating clinician, NOT equally suited for treatment with either aspirin or low-molecular-weight heparin
• 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