Low-dose aspirin protocol for venous thromboembolism prevention after total knee arthroplasty: A large Middle Eastern cohort

Objectives: After total knee arthroplasty (TKA), venous thromboembolic complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE) continue to contribute to post-operative morbidity. Although potent anticoagulants reduce these complications, they are associated with drawbacks. Low-dose aspirin has emerged as an alternative with a favorable safety profile. However, data from the Middle East remains limited. Therefore, we assessed the safety of aspirin-based thromboprophylaxis in a large Saudi cohort undergoing TKA. Methods: A retrospective investigation was conducted at a single tertiary hospital in Saudi Arabia. Patients who had primary TKA between January 2022 and January 2026 and received low-dose aspirin (100 mg twice daily for 30 days) for thromboprophylaxis were included. The primary outcomes were symptomatic DVT and PE. No routine screening for DVTs or PEs was performed. Secondary outcomes included bleeding, gastrointestinal events, cardiovascular events, and mortality. Results: A total of 1151 TKAs were analyzed (961 patients), including 190 staged bilateral procedures. Females represented 81% of the cohort. No post-operative symptomatic DVT or bleeding was documented. One patient (0.09%) developed PE on post-operative day two and was successfully treated with anticoagulation. One (0.09%) unexplained mortality occurred 10 days after surgery. One stroke (0.09%) and two myocardial infarctions (0.17%) were also observed post-operatively. Minor gastrointestinal irritation occurred in four patients (0.3%). Conclusion: Low-dose aspirin protocol demonstrated a favorable safety profile with extremely low rates of symptomatic DVT, PE, and bleeding following TKA. These findings provide regional observational data regarding an aspirin-based thromboprophylaxis protocol.