Low-Dose Aspirin Decreases Rate of Periprosthetic Joint Infection After Total Joint Arthroplasty

Researchers compared low- vs high-dose aspirin for venous thromboembolism prophylaxis on the rate of periprosthetic joint infection following total joint arthroplasty.

Low-dose aspirin for venous thromboembolism (VTE) prophylaxis was found to decrease the rate of periprosthetic joint infection (PJI) compared with high-dose aspirin among patients who underwent total joint arthroplasty, according to study results published in The Journal of Arthroplasty.

This retrospective cohort study was conducted at Thomas Jefferson University in Philadelphia among patients undergoing either total knee arthroplasty (TJA) or total hip arthroplasty (THA) between 2008 and 2020. Researchers assessed the rate of postoperative PJIs among patients who received low-dose aspirin (81 mg twice daily) compared with those who received high-dose aspirin (325 mg twice daily) as prophylaxis against VTE. Eligible patients included those who received a full course of prophylactic aspirin, defined as aspirin use for 2 weeks or more after hospital discharge. Results were assessed via logistic regression with adjustments for demographic and surgical covariates, including patient age, sex, BMI, Charlson comorbidity index, operative time, operated joint, and tranexamic acid use.

A total of 15,825 patients were included in the analysis, of whom 8,761 received low-dose aspirin and 7,064 received high-dose aspirin. Of the patients in the low- and high-dose aspirin groups, the median age was 64 (range, 12-101) and 63 (range, 16-96) years, 54.2% and 53.3% were women or girls, 7.1% and 2.5% had diabetes mellitus (P <.001), 58.7% and 51.9% underwent THA, and 41.3% and 48.1% underwent TKA (P <.001).

The researchers found that high-dose aspirin was associated with an increased rate of PJIs, with PJI occurring among 0.35% of patients in the high-dose group vs 0.1% in the low-dose group (P =.001). The increased rate of PJIs associated with high- vs low-dose aspirin was also observed when evaluating patients who underwent TKA (0.32% vs 0.06%; P =.019) and those who underwent THA (0.38% vs 0.14%; P =.035) separately in secondary analyses.

The adjusted logistic regression analysis showed that high-dose aspirin was associated with a significantly increased risk for PJI (odds ratio [OR], 2.59; 95% CI, 1.15-6.40; P =.028). Variables associated with a significantly increased risk for PJI included BMI (OR, 1.10; 95% CI, 1.03-1.17; P =.003), and those associated with a significantly decreased risk included receipt of perioperative tranexamic acid (OR, 0.46; 95% CI, 0.21-0.97; P =.045).

Using platelet count as a predictor for PJI, a cutoff value of 286.00×109/L was predictive of PJI occurrence among patients in the low-dose aspirin group, with an area under the curve (AUC) of 0.64, a sensitivity of 0.78, and a specificity of 0.68. For patients in the high-dose aspirin group, a platelet count with a cutoff value of 271.00×109/L was predictive of PJI occurrence, with an AUC of 0.47, a sensitivity of 0.40, and a specificity of 0.68.

The rates of acute myocardial infarction (P =.114), cerebrovascular accident (P =.159), gastrointestinal ulcer (P =1.000), and gastrointestinal hemorrhage (P =1.000) did not significantly differ between patients in the high- and low-dose aspirin groups.

This study was limited by its retrospective design and potential confounders.

The researchers suggested that future studies should compare the prophylactic use of aspirin with “other common VTE prophylactic agents, such as low-molecular weight heparin or warfarin…”


Najafi F, Kendal JK, Peterson NV, et al. Low dose aspirin for venous thromboembolism prophylaxis is associated with lower rates of periprosthetic joint infection after total joint arthroplasty. J Arthroplasty. 2022;S0883-5403(22)00691-X. doi:10.1016/j.arth.2022.07.006