ANTICOAGULATION STRATEGIES IN SEPTIC SINGLE-STAGE HIP REVISION: IS ASPIRIN COMPARABLE TO OTHER ANTICOAGULANTS?

Aims Septic hip revision (rTHA) for prosthetic joint infection is associated with increased venous thromboembolic (VTE) complications compared to aseptic rTHA. Furthermore, previous studies reported Aspirin to be safe and effective in rTHA, however, VTE prophylaxis after septic single-stage rTHA hasn't been described. In this study, we aim to compare the safety and effectiveness of Aspirin with other anticoagulants following septic single-stage rTHA. Methods We queried the TriNetX database (cases from 2006 till 2025) for patients undergoing their first septic single-stage rTHA. Patients who were prescribed Aspirin monotherapy for prophylaxis (defined as prescription within 2 weeks after surgery) were compared to patients prescribed monotherapy of Enoxaparin, Apixaban or Rivaroxaban (non-Aspirin) and to patients prescribed a combination of Aspirin and non-Aspirin (dual therapy). 1:1 propensity score matching was performed using the Aspirin cohort as reference to control for relevant variables, including age at time of surgery, sex, history of VTE, stroke, cancer, coagulopathy, tranexamic acid use, body mass index, glycemic control and smoking. Outcomes of interest were the 90-day incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), VTE, re-revision, death, transfusion, wound disruption and surgical site infection (SSI). Significance was set at p<0.05. Results The matched Aspirin-non-Aspirin cohorts included 978 patients each. The non-Aspirin cohort had a significantly increased incidence of DVT (3.68% vs 2.15%, p=0.044) and VTE (5.11% vs 3.07%, p=0.022) compared to the Aspirin cohort. The rates of PE (1.84% vs 1.13%, p=0.190), re-revision (11.25% vs 12.37%, p=0.441), death (2.66% vs 2.35%, p=0.664), transfusion (9.61% vs 8.79%, p=0.532), bleeding (4.19% vs 4.50%, p=0.739), wound disruption (6.34% vs 5.52%, p=0.444), and SSI (2.05% vs 2.66%, p=0.371) were similar between both cohorts. In contrast, the matched dual therapy-Aspirin cohorts each comprised 749 patients with no difference in the rates of DVT (2.94% vs 1.87%, p=0.177), VTE (4.27% vs 3.07%, p=0.216), re-revision (13.62% vs 12.28%, p=0.442), death (1.60% vs 2.00%, p=0.560), transfusion (9.75% vs 8.41%, p=0.369), bleeding (4.14% vs 4.27%, p=0.898), wound disruption (6.01% vs 6.14%, p=0.914) and SSI (3.20% vs 2.67%, p=0.541). Conclusion This is the first study to compare VTE prophylaxis agents in the setting of septic single-stage rTHA. Aspirin was associated with lower DVT and VTE compared to non-Aspirin monotherapy and similar outcomes compared to dual therapy. Our data suggests that Aspirin is safe and non-inferior compared to other anticoagulant regimens following septic single-stage rTHA. Further prospective studies are needed to confirm these findings.