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Low-Dose Aspirin: The Safest Prophylactic Approach for Venous Thromboembolism Prevention Following Total Hip
Joshua R Porto1, Monish S Lavu1, Christian J Hecht2
1Case Western Reserve University School of Medicine, Cleveland, Ohio.
Background:
Venous thromboembolism (VTE) remains a major concern following total hip arthroplasty (THA). While multiple agents are used for chemoprophylaxis, the 2022 International Consensus Meeting (ICM) on VTE endorsed low-dose aspirin as the preferred option for all THA patients. However, data comparing aspirin with other anticoagulants across different VTE risk profiles remain limited.
Methods:
This retrospective cohort study analyzed patients undergoing primary THA between 2012 and 2023 using a large national database. Patients were stratified into VTE high-risk and low-risk groups based on ICM criteria and comorbidities identified in prior national analyses. Chemoprophylactic regimens included low-dose aspirin (81 mg) and other anticoagulants; patients receiving high-dose aspirin were excluded. Among 147,437 THA patients, use of low-dose aspirin increased from 0.4% in 2012 to 60.9% in 2023. Outcomes included 90-day rates of deep vein thrombosis, pulmonary embolism, hemorrhage, hematoma, gastrointestinal bleeding, infection, myocardial infarction, stroke, mortality, revision, emergency department visits, and readmissions. Propensity score matching (1:1) was applied to control for demographic and clinical variables. Statistical significance was defined as P < 0.05.
Results:
In both high- and low-risk groups, aspirin-only prophylaxis was associated with lower odds of deep vein thrombosis (odds ratio (OR): 0.29 high-risk, 0.16 low-risk), pulmonary embolism (OR: 0.32 to 0.25), hemorrhage (OR: 0.13 to 0.09), gastrointestinal bleeding (OR: 0.42 to 0.27), and mortality (OR: 0.33 to 0.48) compared to alternative agents.
Conclusions:
Low-dose aspirin was associated with significantly lower rates of thromboembolic, bleeding, and mortality outcomes in both high- and low-risk THA patients. These findings support the ICM recommendation of aspirin as a safe, effective, and broadly applicable thromboprophylaxis strategy following THA.
Level Of Evidence:
Therapeutic Level III.
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