Venous Thromboembolism Prophylaxis After Revision Hip Arthroplasty: A Multicenter Analysis of Anticoagulant Choice and Weight-Bearing Status.

Background: Aspirin (ASA) is a reliable prophylactic agent for venous thromboembolism (VTE) in revision total hip arthroplasty (THA). While several studies have compared ASA to other anticoagulants, to our knowledge, none have evaluated its effectiveness in patients who have restricted weight-bearing status (WBS). Limited mobilization after surgery increases the risk of VTE complications. This study aimed to assess the effects of WBS and anticoagulant choice on the rates of thrombotic and bleeding complications after revision of THA.

Methods: We reviewed 3,000 revision THAs performed between 2019 and 2022 across four institutions. Data collected included demographic factors, comorbidities, indication for revision, WBS (weight bearing as tolerated [WBAT] versus non-WBAT), anticoagulant choice, and Caprini VTE risk assessment score. Incidences of VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), drainage, hematoma, and periprosthetic joint infections were recorded. Multivariate logistic regression was used to evaluate the associations between postoperative thrombotic and bleeding events, prophylactic pharmacologic agents, and WBS.

Results: The incidence of VTE, DVT, and PE was significantly lower in the ASA cohort compared to the non-ASA cohort (VTE: 1.2 versus 3.5%, P < 0.001; DVT: 0.9 versus 3.3%, P < 0.001; PE: 0.2 versus 0.9%, P < 0.001). Within the ASA cohort, the incidence of VTE (1.1 versus 1.1%), bleeding complications (4.5 versus 4.5%), and periprosthetic joint infection (5.1 versus 5.8%) were similar when stratified by WBAT and non-WBAT. Multivariate regression demonstrated that ASA prophylaxis decreased the likelihood of VTE compared to non-ASA (odds ratio: 0.35, confidence interval: 0.19 to 0.57, P < 0.001). Weight-bearing status was not a risk factor regarding VTE or bleeding events.

Conclusions: Aspirin is a safe and effective prophylactic option for VTE in revision THA, regardless of WBS. While the lower VTE incidence in the ASA group suggests efficacy, potential selection bias must be considered.