ArticleJournal of orthopaedic case reports2025
Comparative Effectiveness of Aspirin and Low-molecular-weight heparin for Venous Thromboembolism Prophylaxis after Total Hip Arthroplasty.
Article in Journal of orthopaedic case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Total hip arthroplasty (THA) carries a persistent risk of venous thromboembolism (VTE). Contemporary guidelines endorse combined mechanical and pharmacologic prophylaxis often extended to 35 days post-operative; yet the optimal agent remains debated as evidence comparing aspirin with low-molecular-weight heparin (LMWH) is mixed (e.g., EPCAT II vs. CRISTAL). Materials and Methods: We conducted a retrospective, propensity-matched cohort study using the TriNetX Network. Adults undergoing primary THA were assigned to mutually exclusive cohorts based on initial post-operative chemoprophylaxis within 7 days: Aspirin (no LMWH exposure in days 0-7) or LMWH (no aspirin exposure in days 0-7). Outcomes were assessed from post-operative day 1 to day 365. One-to-one propensity score matching balanced age, sex, race/ethnicity, body mass index, hypertension, ischemic heart disease, heart failure, diabetes, obesity, and metabolic disorders. Effect measures included risk difference (RD) with two-sided P (primary; also applied to risk ratio [RR] per protocol), (RR, 95% confidence interval [CI]), and hazard ratio (HR) from Kaplan-Meier analysis with log-rank P. Statistical significance was set at P < 0.05. Guideline context is provided for interpretability. Results: After matching (aspirin n = 8,559; LMWH n = 8,559), 1-year outcomes favored aspirin for thromboembolism. Any VTE: 1.7% versus 2.6%; RR = 0.649 (0.525-0.803), P < 0.001; and HR = 0.635, P = 0.475. Deep vein thrombosis: 1.4% versus 2.3%; RR = 0.610 (0.485-0.769), P < 0.001; and HR = 0.598, P = 0.142. Pulmonary embolism (PE): 0.6% versus 1.0%; RR = 0.665 (0.472-0.935), P = 0.018; and HR = 0.651, P = 0.603. Major bleeding: 11.1% versus 10.2%; RR = 1.089 (0.999-1.188), P = 0.053; and HR = 1.094, P = 0.001. Minor bleeding: 2.2% versus 2.1%; RR = 1.050 (0.858-1.284), P = 0.637; and HR = 1.029, P = 0.969. Emergency department visit: 13.6% versus 18.7%; RR = 0.727 (0.679-0.780), P < 0.001; and HR = 0.694, P = 0.463. Findings align with guidance permitting aspirin as prophylaxis in appropriately selected arthroplasty patients, while acknowledging randomized evidence favoring LMWH in some settings. Conclusions: In matched THA patients, aspirin achieved lower 1-year VTE than LMWH with no statistically significant increase in major bleeding by RD. Given trial heterogeneity (e.g., CRISTAL versus meta-analyses and step-down strategies), agent selection should be individualized, balancing thrombotic and bleeding risks, logistics, and patient preference within guideline-concordant, extended prophylaxis pathways (Two-sided significance threshold: P < 0.05).
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