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Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?
Itay Ashkenazi1, Haggai Schermann2, Aviram Gold2
1Adult Reconstruction Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. itay.ashkenazi@gmail.com.
Insights
Continuing aspirin therapy before hip replacement surgery is safe. This study found no increased bleeding or complications, suggesting aspirin can be safely continued for total hip arthroplasty patients.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Medicine
- Pharmacology
Background:
- Acetylsalicylic acid (aspirin) is frequently prescribed, particularly for patients undergoing total hip arthroplasty (THA).
- Discontinuing aspirin pre-THA may reduce bleeding but could elevate cardiovascular event risk.
- This study investigated the safety of continuous aspirin use during elective THA.
Purpose of the Study:
- To evaluate the safety and efficacy of continuing aspirin treatment in patients undergoing elective total hip arthroplasty.
- To compare perioperative outcomes between patients who continued aspirin and those who did not.
Main Methods:
- Retrospective analysis of a consecutive cohort undergoing elective THA (2011-2018).
- Patients were divided into two groups: continuous preoperative aspirin and no aspirin.
- Key outcomes included blood loss, complications, readmissions, and mortality.
Main Results:
- Continuous aspirin use did not significantly increase perioperative bleeding (hemoglobin change, P=0.72).
- No significant differences were observed in mortality (short-term P=0.47, long-term P=0.4), readmissions (P=0.78), infections (P=1.0 and P=0.47), or cardiovascular events.
- The aspirin group had 205 patients, while the non-aspirin group comprised 552 patients.
Conclusions:
- Continuing aspirin perioperatively in elective primary THA is safe and does not elevate complications or mortality.
- Findings challenge the routine practice of withholding aspirin before THA.
- Maintaining aspirin may preserve its cardioprotective benefits against thrombotic events.
Introduction:
Acetylsalicylic acid (aspirin) is a commonly prescribed medication, especially in the age group of individuals who undergo elective total hip arthroplasty (THA). Preoperative discontinuation of aspirin is believed to reduce intraoperative bleeding and other complications, but it may increase the risk of perioperative cardiovascular events. In this study we have sought to evaluate the safety of continuous aspirin treatment in patients undergoing elective THA.
Materials And Methods:
This is a retrospective analysis of a consecutive cohort who underwent elective THA in a tertiary medical center between 2011 and 2018. The cohort was divided into two groups-one that received continuous preoperative aspirin treatment and one that did not. Blood loss, peri- and postoperative complications, readmissions, and short- and long-term mortality were compared between groups.
Results:
Out of 757 consecutive patients (293 males, 464 females) who underwent elective primary THA, 552 were in the "non-aspirin" group and 205 were in the "aspirin" group and were not treated preoperative with other medication affecting hemostasis. Perioperative continuation of aspirin treatment did not significantly increase perioperative bleeding, as indicated by changes in hemoglobin levels (P = 0.72). There were no significant differences in short- and long-term mortality (P = 0.47 and P = 0.4, respectively) or other perioperative complications, such as readmission (P = 0.78), deep or superficial infection (P = 1 and P = 0.47, respectively), and cardiovascular events (none in both groups).
Conclusion:
Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. The protective effects of aspirin from postoperative thrombotic and cardiovascular events are well documented. The current findings dispute the need to preoperatively withhold aspirin treatment in patients undergoing elective primary THA.
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