Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?
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HIP ARTHROPLASTY
Is continuation of anti‑platelet treatment safe for elective total hip arthroplasty patients? Itay Ashkenazi1 · Haggai Schermann1 · Aviram Gold1 · Ron Gurel1 · Ofir Chechik1 · Yaniv Warschawski1 · Ran Schwarzkopf2 · Nimrod Snir1 Received: 23 March 2020 / Accepted: 30 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Aspirin · Total hip arthroplasty · Perioperative complications · Postoperative period Abbreviations THA Total hip arthroplasty COX Cyclooxygenase enzyme VTE Venous thromboembolism SES Socioeconomic status POD Postoperative day ASA American Society of Anesthesiology Itay Ashkenazi and Haggai Schermann have equal contribution. * Itay Ashkenazi [email protected] 1
Adult Reconstruction Unit, Division of Orthopedics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Hospital for Joint Diseases, NYU Langone Orthopedic Hospital, New York, USA
2
Introduction Total hip arthroplasty (THA) is a common surgical procedure with
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