Is Low-Dose Aspirin the Safest Prophylaxis for Venous Thromboembolism Following Primary Total Hip Arthroplasty?

Abstract

Venous thromboembolism (VTE) remains a serious complication following primary total hip arthroplasty (THA), prompting routine use DA) of perioperative chemoprophylaxis. In 2022, the International Consensus Meeting (ICM) endorsed low-dose aspirin (L as the preferred VTE prophylactic agent for both hip and knee arthroplasty patients. Prior THA studies often lacked stratification by VTE risk and direct comparisons between aspirin monotherapy, combination regimens, and alternative anticoagulants. This study aimed to evaluate the safety and efficacy of LDA monotherapy compared to other anticoagulants across high- and low-risk THA cohorts. A large national database identified 141,334 patients who underwent primary THA from 2012 to 2025. Patients were stratified into high- and low-risk cohorts based on ICM-VTE criteria. Propensity score matching (1:1) was performed to compare 90-day outcomes between patients receiving LDA monotherapy and those receiving alternative anticoagulants (low-molecular-weight heparin, direct oral anticoagulants, or warfarin). Primary outcomes included VTE, defined as deep vein thrombosis (DVT) or pulmonary embolism (PE). Secondary outcomes included bleeding complications, infections, mortalities, and healthcare utilization. Subgroup analyses compared LDA with combination prophylaxis (LDA plus another anticoagulant) and rivaroxaban monotherapy. The LDA monotherapy was associated with significantly lower odds of DVT and PE compared to other anticoagulants across both high-risk (DVT odds ratio (OR):0.37, P < 0.001; PE OR:0.51, p<0.001), and low-risk (DVT OR:0.22, p<0.001; PE OR:0.40, p<0.001) patients. The LDA-only regimens also demonstrated reduced rates of hemorrhages, infections, transfusions, readmissions, emergency department visits, and mortalities. In contrast, combination prophylaxis was associated with increased VTE risk and complication rates compared to LDA alone, while rivaroxaban monotherapy showed no significant differences when compared with LDA. The LDA monotherapy was associated with reduced rates of VTE and major postoperative complications compared to alternative strategies in both high- and low-risk THA patients. These findings align with a recent TKA study and support the 2022 ICM-VTE recommendations endorsing LDA as a safe and effective prophylactic option across THA patient risk profiles.