Trial Search Results

Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement

PEPPER is a randomized study comparing the three most commonly used anticoagulants in North America in patients who have elected to undergo primary or revision hip or knee joint replacement surgery. The anticoagulants being compared are enteric coated aspirin, low intensity warfarin, and rivaroxaban.

Stanford is currently not accepting patients for this trial.

Lead Sponsor:

Medical University of South Carolina

Collaborator: Brigham and Women's Hospital

Stanford Investigator(s):


  • Drug: Enteric Coated Aspirin
  • Drug: Warfarin
  • Drug: Rivaroxaban


Phase 4


Inclusion Criteria:

   1. Males and females 21 years of age or older;

   2. Undergoing elective primary, resurfacing arthroplasty, revision, or second stage
   re-implantation total hip replacement;

   3. Undergoing elective primary, revision, or second stage re-implantation total or uni
   compartmental knee replacement;

   4. Patient has necessary mental capacity to participate and is able to comply with study
   protocol requirements;

   5. Patient is willing and able to give informed consent; and

   6. Patient is willing to be randomized and participate.

Exclusion Criteria:

   1. Patients undergoing bilateral hip or knee replacement;

   2. Patients undergoing total hip or knee replacement who have been enrolled in this study
   for a prior hip or knee replacement;

   3. Patients who are concurrently enrolled in another active interventional clinical trial
   testing a drug or intervention known or believed to interact with aspirin, warfarin,
   or rivaroxaban;

   4. Patients who have a contraindication to two or more of the three study prophylaxis

   5. Women who are pregnant or breastfeeding, as well as those of reproductive potential
   unless there is a negative urine pregnancy test on the day of surgery;

   6. Patients on chronic (longer than the prior 6 months) anticoagulation other than with
   antiplatelet medications;

   7. Patients with documented gastrointestinal, cerebral, or other hemorrhage within 3
   months of the operation;

   8. Patients with a known diagnosis of defective hemostasis and past history of clinical
   bleeding requiring transfusion and treatment;

   9. Patients who have had an operative procedure involving the eye, ear, or central
   nervous system within one month;

10. Patients with severe uncontrolled hypertension with systolic BP > 220mmHg or diastolic
   BP > 120mmHg;

11. Patients with an absolute body weight of less than 41 kilograms (90.4 lbs) at baseline

12. Vulnerable patient populations including prisoners and institutionalized individuals.

Ages Eligible for Study

21 Years - N/A

Genders Eligible for Study


Not currently accepting new patients for this trial

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
William Maloney
Not Recruiting