Low-Dose Aspirin for Venous Thromboembolism Prophylaxis is Associated With Lower Rates of Periprosthetic Joint Infection After Total Joint Arthroplasty

Authors

Farideh Najafi, Thomas Jefferson UniversityFollow
Joseph K. Kendal, University of California Los Angeles
Nicholas V. Peterson, University of California Los Angeles
Kerri-Anne Ciesielka, Thomas Jefferson UniversityFollow
Camilo Restrepo, Thomas Jefferson UniversityFollow
Javad Parvizi, Thomas Jefferson UniversityFollow
Nicholas M. Bernthal, University of California Los Angeles

Document Type

Article

Publication Date

12-1-2022

Comments

This article is the authors' final version prior to publication in The Journal of Arthroplasty, Volume 37, Issue 12, December 2022, Pages 2444-2448.e1.

The published version is available at https://doi.org/10.1016/j.arth.2022.07.006. Copyright © Elsevier Inc.

Abstract

BACKGROUND: Aspirin as a venous thromboembolism (VTE) prophylactic agent has been shown to have antistaphylococcal and antibiofilm roles. Optimal acetylsalicylic acid (ASA) dosage would facilitate antimicrobial effects while avoiding over-aggressive inhibition of platelet antimicrobial function. Our purpose was to determine the periprosthetic joint infection (PJI) rate after total joint arthroplasty in patients receiving low-dose ASA (81 mg twice a day), in comparison to high-dose ASA (325 mg twice a day).

METHODS: We conducted a retrospective cohort study between 2008 and 2020. Eligible patients were older than 18 years, underwent primary total joint arthroplasty, both total knee arthroplasty and total hip arthroplasty, had a minimum 30-day follow-up, and received a full course ASA as VTE prophylaxis. Patients' records were reviewed for PJI, according to Musculoskeletal Infection Society criteria. Patients were excluded if they underwent revision arthroplasty, had a history of coagulopathy, or had an ASA regimen that was not completed. In total 15,825 patients were identified, 8,761 patients received low-dose ASA and 7,064 received high-dose ASA.

RESULTS: The high-dose cohort had a higher PJI rate (0.35 versus 0.10%, P = .001). This relationship was maintained when comparing subgroups comprising total knee arthroplasty (0.32 versus 0.06%, P = .019) or total hip arthroplasty (0.38 versus 0.14%, P = .035) and accounting for potentially confounding demographic and surgical variables (odds ratio = 2.59, 95% CI = 1.15-6.40, P = .028).

CONCLUSION: Comparing low-dose to high-dose ASA as a VTE prophylactic agent, low-dose ASA had a lower PJI rate. This may be attributable to a balance of anti-infective properties of ASA and antiplatelet effects.

Recommended Citation

Najafi, Farideh; Kendal, Joseph K.; Peterson, Nicholas V.; Ciesielka, Kerri-Anne; Restrepo, Camilo; Parvizi, Javad; and Bernthal, Nicholas M., "Low-Dose Aspirin for Venous Thromboembolism Prophylaxis is Associated With Lower Rates of Periprosthetic Joint Infection After Total Joint Arthroplasty" (2022). Department of Orthopaedic Surgery Faculty Papers. Paper 180.
https://jdc.jefferson.edu/orthofp/180

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

35843380

Language

English