Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement

Completed · Phase 4

Conditions studied: Pulmonary Embolism, Venous Thrombosis

In brief

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.

Key facts

Study ID

NCT02810704

Run by

Dartmouth-Hitchcock Medical Center

People needed

18883

Starts

2016-12-01

Expected to finish

2025-09-01

Last updated by the study team

2026-04-09

Who can join

Age: 21 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• 21 years of age or older;
• Undergoing elective primary, revision or second stage re-implantation total hip/knee replacement or uni-compartmental knee replacement or hip resurfacing arthroplasty;
• Has necessary mental capacity to participate and is able to comply with study protocol requirements;
• Eligible for randomization to at least two of the three study regimens;
• Is not pregnant on the day of surgery;
• Has signed the consent form; and
• Is willing to be randomized and participate in the study.

You may not qualify if…

• Undergoing bilateral hip or knee replacement;
• Has been previously enrolled;
• Is pregnant or breastfeeding;
• Is on chronic anticoagulation other than antiplatelet medications;
• Concurrently enrolled in another active interventional clinical trial testing a drug or intervention known or believed to interact with aspirin, warfarin, or rivaroxaban;
• Has documented gastrointestinal, cerebral, or other hemorrhage within 3 months;
• Has a known diagnosis of defective hemostasis and past history of clinical bleeding requiring transfusion and treatment;
• Has had an operative procedure involving the eye, ear, or central nervous system within one month;
• Has uncontrolled hypertension with systolic BP > 220mmHg or diastolic BP > 120mmHg;
• Body weight of less than 41 kilograms at baseline visit;
• Member of a vulnerable patient population.

Where it is running

• Mayo Clinic — Scottsdale, Arizona, United States
• University of Arkansas for Medical Sciences — Little Rock, Arkansas, United States
• UCLA — Los Angeles, California, United States
• Stanford University Hospital — Stanford, California, United States
• Arthritis Surgery Research Foundation — South Miami, Florida, United States
• Rush University Medical Center — Chicago, Illinois, United States
• Indiana University — Indianapolis, Indiana, United States
• Sinai Hospital — Baltimore, Maryland, United States
• Johns Hopkins University — Baltimore, Maryland, United States
• Brigham & Women's Hospital — Boston, Massachusetts, United States
• Boston University Medical Center — Boston, Massachusetts, United States
• Beth Israel Deaconess Medical Center — Boston, Massachusetts, United States
• Lahey Clinic — Burlington, Massachusetts, United States
• Mayo Clinic — Rochester, Minnesota, United States
• University of Nebraska Medical Center — Omaha, Nebraska, United States
• Dartmouth-Hitchcock Medical Center — Lebanon, New Hampshire, United States
• New York University — New York, New York, United States
• Northwell Health — New York, New York, United States
• Duke University Medical Center — Durham, North Carolina, United States
• Cleveland Clinic — Cleveland, Ohio, United States
• Penn State Hershey Med Center — Hershey, Pennsylvania, United States
• University of Pennsylvania — Philadelphia, Pennsylvania, United States
• Lifespan Health — East Providence, Rhode Island, United States
• Medical University of South Carolina — Charleston, South Carolina, United States
• University of Utah — Salt Lake City, Utah, United States

Full record on ClinicalTrials.gov

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