History of Venous Thromboembolism Is Not a Contraindication to Aspirin Prophylaxis in Patients Undergoing Total Joint...

Although aspirin has become the prophylactic agent of choice for venous thromboembolism (VTE) prevention in low VTE risk patients undergoing primary total joint arthroplasty (TJA), there remains a paucity of data in the literature on the efficacy of aspirin as a mode of chemoprophylaxis in patients who have previously experienced a VTE episode. The purpose of this study was to determine the efficacy of aspirin versus other anticoagulant medications in primary TJA patients who have a documented history of a prior thromboembolic event.

This study used a national database to identify patients who underwent primary TJA between 2010 and 2023. Only patients who had a documented history of a VTE event were included. Using demographic data, medical comorbidities, and preoperative anticoagulation use, primary TJA patients who had a history of VTE who received nonaspirin medications for thromboprophylaxis were propensity score-matched on a 3:1 basis to those who received aspirin. Patients who had either an active or previous history of cancer were excluded. A total of 3,132 matched patients undergoing primary total knee arthroplasty and 2,867 matched patients undergoing primary total hip arthroplasty were included in the analysis.

Among total knee arthroplasty patients, aspirin use was associated with comparable odds of deep vein thrombosis (DVT) (odds ratio [OR] 0.80; 95% confidence interval [CI], 0.49 to 1.31) and significantly lower odds of pulmonary embolism (PE) (OR 0.33; 95% CI, 0.12 to 0.85). Similarly, in the total hip arthroplasty cohort, aspirin users had comparable odds of DVT (OR 0.67; 95% CI, 0.34 to 1.32) and lower odds of PE (OR 0.19; 95% CI, 0.05 to 0.93).

We found that patients who had a prior VTE episode and no oncologic history receiving aspirin thromboprophylaxis following primary TJA had comparable odds of developing DVT and lower odds of experiencing PE relative to patients receiving other types of anticoagulation. Based on these findings, it appears that aspirin may be a suitable method of VTE prophylaxis in patients undergoing TJA with a prior thromboembolic episode; however, prospective studies are warranted to confirm the optimal anticoagulation strategy in this high-risk cohort.