Aspirin Is Safe Compared to Other Anticoagulants to Prevent Venous Thromboembolism After Revision Total Hip Arthroplasty

Background Venous thromboembolism (VTE) remains a significant postoperative complication following revision total hip arthroplasty (rTHA) as in some instances the lower extremity weight bearing may be limited. It remains unclear how other anticoagulants perform compared to aspirin (ASA) in such setting. This study aims to compare the 90-day incidence of VTE complications and death among patients receiving different thromboprophylaxis regimens: ASA, apixaban, rivaroxaban, and enoxaparin following aseptic rTHA. Methods Using the TriNetX database, we queried aseptic THAr cases. Patients were stratified based on the anticoagulant administered postoperatively. 90-day incidence rates of proximal DVT, distal DVT, PE, VTE and death were compared across groups before and after 1:1 propensity score matching for relevant demographics and comorbidities. Results Before matching, Apixaban was associated with a significantly higher rate of proximal DVT (1.2% vs 0.6%, p=0.014), PE (3% vs 1%, p<0.0001), death (2.3% vs 1.6%, p=0.031) and VTE (6% vs 2.4%, p<0.0001) compared to ASA. Rivaroxaban showed a higher incidence of PE (2.3% vs 1%, p<0.0001) and VTE (5.1% vs 2.4%, p<0.0001) compared to ASA. Enoxaparin was associated with higher rates of proximal DVT (1.1% vs 0.6%, p<0.0001), PE (1.9% vs 1%, p<0.0001), death (3.1% vs 1.6%, p<0.0001) and VTE (4.2% vs 2.4%, p<0.0001) relative to ASA. After propensity score matching, enoxaparin was associated with increased rates of death (2.9% vs 1.8%, p<0.0001) and VTE (3.7% vs 2.9%, p=0.014) compared to ASA. We did not appreciate a significant difference in all study outcomes when comparing apixaban and rivaroxaban to ASA after matching. Discussion ASA demonstrated similar 90-day VTE complication and death rates compared to apixaban and rivaroxaban after aseptic rTHA. However, enoxaparin had persistently increased risk of death and VTE compared to ASA even after propensity score matching. Conclusion ASA remains a safe option for postoperative thromboprophylaxis in the setting of aseptic rTHA compared to other anticoagulants.