Aspirin Is Safe for Venous Thromboembolism Prophylaxis for Patients With a History of Gastrointestinal Issues

The safety of acetylsalicylic acid (ASA, aspirin) in patients with prior history of gastroesophageal reflux or peptic ulcer disease remains unclear. The purpose of this study was to determine the safety of ASA for venous thromboembolism (VTE) prophylaxis after total joint arthroplasty in patients with prior history of gastrointestinal (GI) issues.

This was an institutional, retrospective cohort study of 19,044 patients who underwent primary total hip and total knee arthroplasty from 2013 to 2019. We divided the patients into two cohorts based on the presence or absence of pre-existing GI issues. Patient demographics, VTE prophylaxis, and postoperative complications were collected. The primary outcome measure was GI bleed.

In our series, 3090 patients had a preoperative GI issue and 15,954 did not have a GI issue. ASA was the most common mode of VTE prophylaxis (89%), followed by Coumadin (4.7%), direct oralanticoagulants (4.2%), low-molecular-weight heparin (1.7%), and others (0.4%). In the cohort of patients given ASA, there was no significant difference in postoperative GI bleeding between those with (2/1781, 0.11%) and without preoperative GI issues (8/7,628, 0.10%, P = 1.0). In the overall cohort, history of preoperative GI issues was associated with an increased risk of postoperative GI bleeding (0.32% vs 0.11%, P = .031). In logistic regression analysis, ASA was associated with a protective effect against GI bleed (OR = 0.09, 95% CI 0.01-0.40, P = .003).

ASA is safe for VTE prophylaxis after total joint arthroplasty in patients with history of GI issues and is not associated with an increased risk of postoperative GI bleeds.