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Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Acetylsalicylic acid (aspirin) is a commonly prescribed medication, especially in the age group of individuals who undergo elective total hip arthroplasty (THA). Preoperative discontinuation of aspirin is believed to reduce intraoperative bleeding and other complications, but it may increase the risk of perioperative cardiovascular events. In this study we have sought to evaluate the safety of continuous aspirin treatment in patients undergoing elective THA.

Materials and methods

This is a retrospective analysis of a consecutive cohort who underwent elective THA in a tertiary medical center between 2011 and 2018. The cohort was divided into two groups—one that received continuous preoperative aspirin treatment and one that did not. Blood loss, peri- and postoperative complications, readmissions, and short- and long-term mortality were compared between groups.

Results

Out of 757 consecutive patients (293 males, 464 females) who underwent elective primary THA, 552 were in the “non-aspirin” group and 205 were in the “aspirin” group and were not treated preoperative with other medication affecting hemostasis. Perioperative continuation of aspirin treatment did not significantly increase perioperative bleeding, as indicated by changes in hemoglobin levels (P = 0.72). There were no significant differences in short- and long-term mortality (P = 0.47 and P = 0.4, respectively) or other perioperative complications, such as readmission (P = 0.78), deep or superficial infection (P = 1 and P = 0.47, respectively), and cardiovascular events (none in both groups).

Conclusion

Peri-operative continuation of aspirin treatment in patients undergoing elective primary THA did not increase perioperative complications or mortality compared to the non-aspirin-treated patients. The protective effects of aspirin from postoperative thrombotic and cardiovascular events are well documented. The current findings dispute the need to preoperatively withhold aspirin treatment in patients undergoing elective primary THA.

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Abbreviations

THA:

Total hip arthroplasty

COX:

Cyclooxygenase enzyme

VTE:

Venous thromboembolism

SES:

Socioeconomic status

POD:

Postoperative day

ASA:

American Society of Anesthesiology

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Itay Ashkenazi and Haggai Schermann have equal contribution.

Authors and Affiliations

  1. Adult Reconstruction Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Itay Ashkenazi, Haggai Schermann, Aviram Gold, Ron Gurel, Ofir Chechik, Yaniv Warschawski & Nimrod Snir

  2. Hospital for Joint Diseases, NYU Langone Orthopedic Hospital, New York, USA

    Ran Schwarzkopf

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  1. Itay Ashkenazi
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Correspondence to Itay Ashkenazi.

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The study was approved by the medical center’s institutional review board that waived informed consent.

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Ashkenazi, I., Schermann, H., Gold, A. et al. Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?. Arch Orthop Trauma Surg 140, 2101–2107 (2020). https://doi.org/10.1007/s00402-020-03629-7

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  • DOI: https://doi.org/10.1007/s00402-020-03629-7

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