Venous thromboembolism after joint arthroplasty: where do we stand with aspirin?

Venous thromboembolism prophylaxis after total joint arthroplasty remains heterogeneous, particularly regarding the role of aspirin within modern fast-track pathways. Although aspirin is widely used in North American arthroplasty practice, European guidelines remain more conservative and often provide limited or non-operational recommendations for its use after total hip and knee arthroplasty. Contemporary evidence supports aspirin as a viable prophylactic option in selected patients, with potential advantages related to its safety profile, cost, ease of administration and reduced treatment burden. The clinical role of aspirin should be interpreted within a risk-stratified framework that accounts for thromboembolic risk, bleeding risk, surgical complexity, early mobilization and duration of prophylaxis. Available evidence, including recent randomized data, supports aspirin-based prophylaxis in appropriately selected patients, both as part of sequential strategies and, increasingly, as monotherapy within contemporary fast-track pathways. This scoping review synthesizes current guideline-level evidence and contemporary clinical data to clarify practical considerations for agent selection, dosing, duration and aspirin-based prophylaxis after total joint arthroplasty.