Visceral Organ Malignancy in Patients Undergoing Primary Total Hip Arthroplasty: Is There a Role for Aspirin Prophylaxis?

BACKGROUND

Although aspirin has become the prophylactic agent of choice for venous thromboembolism prevention in low-risk patients undergoing primary total hip arthroplasty (THA), there remains a paucity of data in the literature on the efficacy of aspirin as a mode of chemoprophylaxis in patients who had recent cancer. The purpose of this study was to determine the efficacy of aspirin versus other anticoagulant medications in primary THA patients who were diagnosed with a visceral organ malignancy within 1 year before their arthroplasty procedure.

METHODS

This study used a national database to identify patients who underwent primary THA between 2012 and 2022. Only patients who had a diagnosis code for a visceral organ malignancy within 1 year before their primary THA were included. Using demographic data, medical comorbidities, and preoperative anticoagulation use, primary THA patients who had cancer who were prescribed aspirin for thromboprophylaxis (n = 2,342) were propensity score matched on a 1:1 basis to those who were on non-aspirin medications (n = 2,342). The odds of developing 90-day medical and surgical complications were assessed and compared between patients prescribed aspirin only versus other types of chemoprophylaxis. There were 4,684 matched patients undergoing primary THA included in the analysis.

RESULTS

Patients in the aspirin-group had significantly lower odds of developing deep vein thrombosis (1.2 versus 2.0%; odds ratio [OR] 0.58 [0.4 to 0.9]; P = 0.027) and pulmonary embolism (0.5 versus 1.1%; OR 0.44 [0.2 to 0.9]; P = 0.023), when compared to their counterparts in the non-aspirin group. Furthermore, patients prescribed aspirin were significantly less likely to develop periprosthetic joint infection (0.8 versus 1.8%; OR 0.42 [0.2 to 0.7]; P = 0.003).

CONCLUSIONS

Based on these findings, it appears that aspirin is a safe and effective method of venous thromboembolism prophylaxis in patients with an active visceral organ cancer that are undergoing primary THA.