Introduction The optimal chemoprophylactic agent following revision total hip arthroplasty (THA) requires a balance between safety and efficacy. This study assessed bleeding complications and venous thromboembolic (VTE) events in a cohort of patients undergoing first stage revision surgery for the management of periprosthetic joint infection (PJI) of the hip who received aspirin (ASA) for VTE prophylaxis. Methods A contemporary in-patient database was screened from 2016 to 2023 for all patients undergoing revision total hip arthroplasty for PJI using spacer and antibiotic charges to validate accuracy of the patients included. Patients who received ASA were compared to patients who received low-molecular weight heparin (LMWH). Patients with a history of VTE and those taking other prophylactic agents were excluded. Propensity score matching was used to balance cohorts. To account for residual confounding, multivariable logistic regression models were then used to assess our primary outcomes of VTE and postoperative transfusion. Results 5,272 patients were matched 1:1 based on VTE prophylaxis type. Both cohorts were 65 years old on average. The average Charlson comorbidity index was similar for both cohorts (3.0 vs. 3.1, p=0.24). The groups had a similar rate of tranexamic acid (66.3% vs. 67.3%) use. ASA patients had equivalent rates of VTE (1.48% vs. 1.48%, p=1.000 deep vein thrombosis: 1.14% vs. 1.14%, pulmonary embolism 0.38% vs. 0.42%; adjusted odds ratio aOR=1.19, 95% confidence interval CI=0.72–1.95). Postoperative transfusion rates were significantly lower in the ASA cohort (11.8% vs 16.7%, p<0.001; aOR=0.62, 95% CI=0.52–0.75). Discussion In patients undergoing revision THA for PJI, ASA chemoprophylaxis was associated with lower postoperative transfusion requirements but equivalent rates of VTE when compared to LMWH.
Telang et al. (Thu,) studied this question.