Aspirin Is Noninferior to Other Anticoagulants in Low-Risk Patients for Venous Thromboembolism Undergoing Aseptic Revision Total Hip Arthroplasty.
Academic Article
Overview
abstract
BACKGROUND: While aspirin (ASA) has been widely adopted as an effective method for deep vein thrombosis (DVT) prevention following primary total hip arthroplasty (THA), concerns remain with regard to its efficacy in the setting of revision THA (rTHA). This study aimed to compare venous thromboembolism (VTE) and transfusion rates between patients receiving ASA versus nonaspirin (non-ASA) anticoagulation following aseptic rTHA. METHODS: Patients undergoing aseptic rTHA from 2016 to 2023 were identified in an administrative database. Exclusion criteria included infection, periprosthetic fracture, prior VTE, coagulopathy, or preoperative anticoagulant use. Patients were grouped by postoperative prophylaxis: ASA alone versus non-ASA anticoagulants. Groups were mutually exclusive, except for patients who started ASA and switched to anticoagulation after a VTE event, who remained in the ASA group. Propensity score matching (1:1) was performed based on demographics, comorbidities, insurances, hospital stays ≤ one day, years, and Current Procedural Terminology codes, yielding 2,031 matched pairs. Logistic regressions adjusted for Current Procedural Terminology codes. Outcomes included 30- and 90-day DVT, pulmonary embolus, VTE, and transfusion rates. RESULTS: Aspirin was associated with lower 90-day DVT (0.4 versus 1.6%, P < 0.001), pulmonary embolus (0.5 versus 1.3%, P = 0.012), and VTE (0.6 versus 2.4%, P < 0.001). Transfusion rates were similar at both 30 and 90 days. Notably, DVT ultrasound use within 30 days was significantly higher in the non-ASA group (5.0%) than the ASA group (3.2%, P = 0.006). Regressions controlling for either single- or both-component revisions still showed reduced odds of VTE with ASA compared to non-ASA prophylaxis. CONCLUSIONS: Aspirin is a safe, effective, and noninferior option for VTE prophylaxis following aseptic rTHA in appropriately selected patients.
