Low-Dose Aspirin: The Safest Prophylactic Approach for Venous Thromboembolism Prevention Following Total Hip Arthroplasty Across All Risk Profiles.

Abstract

Venous thromboembolism (VTE) remains a major concern following total hip arthroplasty (THA). While multiple agents are used for chemoprophylaxis, the 2022 International Consensus Meeting on VTE (ICM) endorsed low-dose aspirin as the preferred option for all THA patients. However, data comparing aspirin with other anticoagulants across different VTE risk profiles remains limited. 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 (DVT), pulmonary embolism (PE), hemorrhage, hematoma, gastrointestinal (GI) bleeding, infection, myocardial infarction (MI), stroke, mortality, revision, emergency department (ED) 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. In both high- and low-risk groups, aspirin-only prophylaxis was associated with lower odds of DVT (odds ratio (OR): 0.29 high-risk, 0.16 low-risk), PE (OR: 0.32, 0.25), hemorrhage (OR: 0.13, 0.09), GI bleeding (OR: 0.42, 0.27), and mortality (OR: 0.33, 0.48) compared to alternative agents. 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.