Aspirin is safe and effective for prevention of deep vein thrombosis following acetabular fracture surgery

BACKGROUND: Patients with acetabular fractures are at significant risk for venous thromboembolism (VTE), yet the optimal chemoprophylactic agent remains undefined. Emerging evidence from elective arthroplasty and general orthopaedic trauma populations suggests that aspirin (ASA) may be a safe and effective alternative to traditional anticoagulants. The purpose of this study was to evaluate the safety and efficacy of ASA compared to other anticoagulants for deep vein thrombosis (DVT) prevention following acetabular fracture surgery. METHODS: A retrospective cohort analysis was performed using a global, web-based health research network that provides on-demand access to de-identified, real-world data from electronic health records and claims. Adult patients (≥18 years) who underwent surgical treatment for acetabular fractures between January 2014 and December 2025 and received VTE prophylaxis within 14 days of surgery were identified. Patients were stratified into ASA (n = 1189) and other anticoagulant (n = 5478) cohorts. Propensity score matching (1:1) was performed to balance baseline characteristics, yielding 1174 patients per cohort. Rates and odds of DVT, emergency department (ED) visits, deep infection, stroke, and readmission were assessed at 14-, 30-, and 90-day postoperative intervals. Temporal trends in VTE prophylaxis utilization were also analyzed. RESULTS: Compared to other anticoagulants, ASA was associated with significantly lower odds of DVT at 14 days (1.11% vs. 2.22%; odds ratio [OR]: 0.494; 95% confidence interval [CI]: 0.253-0.967; P = 0.036), 30 days (1.45% vs. 2.73%; OR: 0.524; 95% CI: 0.290-0.950; P = 0.030), and 90 days (2.56% vs. 4.34%; OR: 0.577; 95% CI: 0.365-0.913; P = 0.018). ASA was also associated with significantly lower odds of ED visits at 90 days (OR: 0.741; 95% CI: 0.570-0.963; P = 0.024). There were no significant differences in deep infection, stroke, or readmission rates. ASA utilization increased from 7.2% in 2014-39.5% in 2025. CONCLUSIONS: ASA is safe and effective for DVT prevention following acetabular fracture surgery and is associated with fewer ED visits compared to other anticoagulants. These findings support the growing adoption of ASA as a VTE prophylactic agent in the acetabular fracture population.