Background: 

In recent years, aspirin has become a popular agent for venous thromboembolism (VTE) prophylaxis following total joint arthroplasty (TJA). Yet patients with a history of VTE are often given more aggressive prophylactic agents because of their increased baseline risk. The purpose of this study was to assess whether aspirin is an effective prophylactic agent in patients with a history of VTE.

Methods: 

This was a single-institution, retrospective cohort study. The electronic clinical records of 36,333 patients undergoing TJA between 2008 and 2020 were reviewed. Data on demographic characteristics, comorbidities, intraoperative factors, and postoperative complications were collected. A propensity score-matched analysis was performed, as well as a multivariate regression analysis to account for confounders.

Results: 

Of the 36,333 patients undergoing TJA, 1,087 patients (3.0%) had a history of VTE and were not receiving chronic non-aspirin. The risk for subsequent VTE was significantly higher (p = 0.03) in patients with a history of VTE (1.4%) compared with patients without prior VTE (0.9%). However, the incidence of VTE was not significantly lower (p = 0.208) in patients with a history of VTE who received aspirin (0.4%) compared with patients who received other VTE prophylaxis (1.5%). Propensity score matching showed no difference in VTE rates between the 2 groups (2.2% compared with 0.55%; p = 0.372). In a regression analysis accounting for VTE risk, the administration of aspirin was not associated with an increased risk for subsequent VTE (adjusted odds ratio, 0.32 [95% confidence interval, 0.02 to 1.66]; p = 0.274).

Conclusions: 

Our findings suggest that, although patients with a history of VTE have an increased baseline risk for subsequent VTE, aspirin may be a suitable VTE prophylaxis in this group of patients.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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对于有静脉血栓栓塞病史且正在接受全关节置换术的患者，阿司匹林可能是一种合适的预防措施

背景： 

近年来，阿司匹林已成为全关节置换术 (TJA) 后静脉血栓栓塞 (VTE) 预防的流行药物。然而，由于基线风险增加，有 VTE 病史的患者通常会给予更积极的预防药物。本研究的目的是评估阿司匹林是否是有 VTE 病史患者的有效预防药物。

方法： 

这是一项单机构的回顾性队列研究。回顾了 2008 年至 2020 年间接受 TJA 的 36,333 名患者的电子临床记录。收集有关人口统计学特征、合并症、术中因素和术后并发症的数据。进行了倾向得分匹配分析，以及多变量回归分析以解释混杂因素。

结果： 

在接受 TJA 的 36,333 名患者中，1,087 名患者（3.0%）有 VTE 病史且未接受长期非阿司匹林治疗。与既往无 VTE 的患者（0.9%）相比，有 VTE 病史的患者（1.4%）随后发生 VTE 的风险显着更高（p = 0.03）。然而，与接受其他 VTE 预防的患者 (1.5%) 相比，接受阿司匹林 (0.4%) 的 VTE 病史患者的 VTE 发生率并没有显着降低 (p = 0.208)。倾向评分匹配显示两组之间的 VTE 发生率没有差异（2.2% 与 0.55%；p = 0.372）。在考虑 VTE 风险的回归分析中，服用阿司匹林与随后发生 VTE 的风险增加无关（调整优势比，0.32 [95% 置信区间，0.02 至 1.66]；p = 0.274）。

结论： 

我们的研究结果表明，尽管有 VTE 病史的患者随后发生 VTE 的基线风险增加，但阿司匹林可能是该组患者的合适 VTE 预防药物。

证据等级： 

治疗级别 III。有关证据级别的完整描述，请参见作者说明。