Is continuation of anti-platelet treatment safe for elective total hip arthroplasty patients?

Itay Ashkenazi*, Haggai Schermann, Aviram Gold, Ron Gurel, Ofir Chechik, Yaniv Warschawski, Ran Schwarzkopf, Nimrod Snir

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2101-2107
Number of pages7
JournalArchives of Orthopaedic and Trauma Surgery
Issue number12
StatePublished - Dec 2020
Externally publishedYes


  • Aspirin
  • Perioperative complications
  • Postoperative period
  • Total hip arthroplasty


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