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Well @TheCurbsiders, thought I forgot about following up on this tweet?! Well, I did. I'm on the inpatient Hospitalist Service. Nevertheless, let's go down this rabid hole together...
So the question remains - what is the best pharmacologic intervention to reduce post-operative VTE after orthopedic surgery. A prior EBM presentation that I routinely give compares Apixaban vs Enoxaparin which finds that the NNT to prevent one major VTE of 166. 
Great, so Apixaban may be better than Enoxaparin (with questionable cost benefit). Apparently, oral anticoagulants, in general, are likely more efficacious than Enoxaparin.
A 2013 RCT showed that, compared to Dalteparin, Aspirin was non-inferior.... This could be interesting from a cost-benefit standpoint! A 2018 RCT showed the same thing (Aspirin vs Rivaroxaban).
...but when we looked at pooled data comparing Aspirin to "Non-Aspirin," we find difference in longer term outcomes which trended towards improved mortality at 30 days (OR 0.39 [0.17-0.86, P=0.02]), 90 days (0.58 [0.32-1.04, P=0.067]), and 1-year (OR 0.51 [0.32-0.81, P=0.0004).
90d readmission rates were also significantly lower (3.5% vs 4.1%, P=0.009). Overall data were not significantly different between 81mg and 325mg. So, when we look at the data... maybe Aspirin is a better option when looking at postop VTE PPX, especially when we consider cost.
So, my recommendation, now is to strongly consider Aspirin for postoperative VTE PPX (TKA/THA) and will need to re-review the data available for medical patients. Should we take a deeper look into overall VTE PPX? Maybe!!
