Aspirin May Be a Suitable Prophylaxis for Cancer Patients Undergoing Primary Total Knee Arthroplasty

Aspirin is the prophylactic agent of choice for venous thromboembolism prevention in low-risk patients undergoing primary total knee arthroplasty (TKA). However, there remains a paucity of data in the literature on the efficacy of aspirin as a mode of chemoprophylaxis in patients who have a diagnosis of cancer. The purpose of this study was to determine the efficacy of aspirin versus other anticoagulant medications in primary TKA patients who had a diagnosis of active visceral organ malignancy within one year of their arthroplasty procedure.

This study utilized a national database to identify patients who underwent primary TKA between 2012 and 2022. Only patients who had a diagnosis code for active visceral organ malignancy within 1 year before their primary TKA were included. Using demographic data, medical comorbidities, and preoperative anticoagulation use, primary TKA patients who have cancer and were prescribed aspirin for thromboprophylaxis (n = 2,833) were propensity score matched on a 1:1 basis to those who were on non-aspirin medications (n = 2,833). The odds ratios (ORs) for developing 90-day medical and surgical complications were determined for patients prescribed aspirin only, when compared to those prescribed other types of chemoprophylaxis.

Patients in the aspirin group had significantly lower odds of developing deep vein thrombosis (1.9 versus 3.2%; OR 0.59 [0.4 to 0.8], P = 0.002) and pulmonary embolism (0.5 versus 1.1%; OR 0.42 [0.2 to 0.8], P = 0.008), when compared to their counterparts in the non-aspirin group. Furthermore, patients prescribed aspirin were significantly less likely to experience an emergency department visit following their procedure (7.9 versus 11.6%; OR 0.65 [0.5 to 0.8], P < 0.001).

Based on these findings, aspirin may be a suitable option for venous thromboembolism prophylaxis in patients who have visceral organ cancer who are undergoing primary TKA.

Level III.