Letter to the Editor: High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study

To the Editor, We read with great interest the article by Gharanizadeh et al., “High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study” 2. In their analysis of 146 patients undergoing THA, the authors reported that patients with high-riding developmental dysplasia of the hip (DDH) who received aspirin for venous thromboembolism (VTE) prophylaxis had a higher likelihood of symptomatic VTE than did patients undergoing THA for other indications. The authors suggested considering more potent thromboprophylactic agents than aspirin for this specific patient population. We commend the authors for their valuable contribution to this field. However, we wish to raise two points regarding preoperative medication and the formulation of postoperative aspirin, which we believe could further enhance the rigor and scientific impact of their findings. First, a growing body of evidence from observational and interventional studies indicates that statins, while primarily used for lipid management and cardiovascular disease prevention, are associated with a significant reduction in VTE incidence 3. A recent study specifically focused on THA patients found that statin use was linked to a lower risk of VTE events within 90 days postoperatively (statin group 0.43% versus nonstatin group 1.13%; p = 0.047) 4. The potential confounding association of statin therapy, therefore, should not be overlooked, as it might influence the interpretation of the study's conclusions regarding the efficacy of aspirin prophylaxis 2. Second, while low-dose aspirin is an established effective agent for VTE prevention in primary total joint arthroplasty, emerging evidence suggests that the formulation of aspirin may impact its prophylactic efficacy. A large retrospective study 1 involving 9232 patients undergoing primary total knee or hip arthroplasty demonstrated that enteric-coated, low-dose aspirin was inferior to chewable aspirin in preventing VTE after TKA. In the study by Gharanizadeh et al. 2, patients initiated low-dose aspirin (80 mg twice daily) on the first postoperative morning. However, the specific formulation of aspirin used (enteric-coated versus plain, etc.) was not detailed, nor was a subgroup analysis performed based on this variable. We posit that such an analysis regarding aspirin formulation might provide a more complete and authoritative assessment of the VTE risk associated with aspirin prophylaxis in high-riding DDH patients undergoing THA. Again, we sincerely thank the authors for their contribution.