Aspirin is Associated with Improved Venous Thromboembolism Prophylaxis Compared with Anticoagulants After Total Hip Arthroplasty in Patients Who Have Prior Hematologic Malignancy.

Abstract

Patients who have prior hematologic malignancies undergoing total hip arthroplasty (THA) have elevated venous thromboembolism (VTE) risk. Although guidelines favor low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) in high-risk patients, these agents may increase bleeding and wound complications. Evidence supporting aspirin in this population remains limited. A national administrative database identified patients diagnosed with a hematologic malignancy and underwent THA between 2010 and 2023. Patients were stratified by postoperative VTE prophylaxis. After propensity score matching, 1,043 patients who received aspirin were matched to 1,484 patients who received non-aspirin anticoagulation on demographics and comorbidities. The primary outcome was 90-day VTE. The secondary outcomes included postoperative complications, readmissions, and mortalities. Subgroup analyses evaluated malignancy-to-THA timing and anticoagulant classes. At 90 days, aspirin was associated with lower DVT rates compared with non-aspirin prophylaxis (0.3 versus 1.1%; odds ratio (OR) 0.25 [0.07 to 0.85]; P = 0.03). There were no differences in pulmonary embolism or mortality. Aspirin was associated with fewer emergency department visits (OR 0.62 [0.48 to 0.80]; P < 0.001), readmissions (OR 0.57 [0.41 to 0.80]; P = 0.001), transfusions (OR 0.44 [0.25 to 0.76]; P = 0.004), and pneumonia (OR 0.38 [0.19 to 0.76]; P = 0.008). Warfarin and LMWH were associated with higher VTE odds compared with aspirin (OR 9.12 and 10.06, respectively; P ≤ 0.002), while no VTE events occurred in the DOAC group. On Cox proportional hazards modeling, patients who received aspirin demonstrated a reduced rate of 90-day DVT compared with those who received non-aspirin anticoagulation (hazard ratio (HR) 0.21 [0.06 to 0.71]). Aspirin prophylaxis after THA in patients who have prior hematologic malignancy was associated with improved VTE prevention compared with anticoagulants and fewer postoperative complications, supporting its use as a safe option in patients who have recent or remote hematological malignancies.