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Patients with major fractures often receive antithrombotic drugs to prevent venous thromboembolism (VTE), but the optimal agent is unclear. This trial from 21 U.S. and Canadian trauma centers included 12,000 hospitalized patients with extremity fractures that were treated operatively or pelvic fractures treated operatively or nonoperatively; patients with fractures limited to hands or forefoot were excluded.
Patients were randomized to receive aspirin (81 mg twice daily) or enoxaparin (usually 30 mg subcutaneously, twice daily), starting during hospitalization. The duration of posthospitalization prophylaxis (median, 21 days) was left to clinician judgment. The lower and upper extremities were involved in 88% and 27% of patients, respectivel…