JOA - 2026-06-09 - Journal Article
Aspirin is Associated with Improved Venous Thromboembolism Prophylaxis Compared with Anticoagulants After Total Hip Arthroplasty in Patients Who Have Prior Hematologic Malignancy.
Paul BR, Verhey JT, Tarabichi S, Van Schuyver PR, Christopher ZK, Bingham JS, Spangehl MJ
Topics
Key Takeaway
In THA patients with prior hematologic malignancy, aspirin was associated with 75% lower 90-day DVT odds versus non-aspirin anticoagulation (OR 0.25; P=0.03), with warfarin and LMWH showing 9–10x higher VTE odds compared to aspirin.
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Summary
This study asked whether aspirin is a safe and effective VTE prophylaxis strategy after THA in patients with prior hematologic malignancy, a population typically classified as high-risk and managed with LMWH or DOACs. Using a national administrative database (2010–2023) with propensity score matching, aspirin was associated with lower 90-day DVT rates (0.3% vs. 1.1%, OR 0.25), fewer readmissions (OR 0.57), fewer transfusions (OR 0.44), and fewer ED visits (OR 0.62) compared to non-aspirin anticoagulation. No VTE events occurred in the DOAC subgroup, and there were no differences in PE or mortality between groups.
Key Limitation
The administrative database cannot distinguish active from remitted hematologic malignancy, meaning the aspirin group may have systematically included patients with lower disease burden or hematologist-directed avoidance of anticoagulation, introducing unmeasured confounding that propensity matching cannot fully address.
Original Abstract
BACKGROUND
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.
METHODS
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.
RESULTS
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]).
CONCLUSION
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.