Letter to Editor regarding article,“Thirty day low-dose versus regular-dose aspirin for venous thromboembolism prophylaxis in primary total joint arthroplasty”

Dear editor:

We have recently carefully analyzed the article “Thirty day low-dose versus regular-dose aspirin for venous thromboembolism prophylaxis in primary total joint arthroplasty.” published by Duke et al. ¹ The authors retrospectively analyzed the effects of different doses of aspirin on venous thromboembolism (VTE) and postoperative complications in 483 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The results showed that compared with patients receiving high-dose aspirin, patients receiving low-dose aspirin had lower rates of bleeding and suture reactions and played no role in preventing VTE, wound complications, and infection at 90 days after surgery. Less than high-dose aspirin. The point of view in this article is significant, and we also recognize the author’s contribution. However, there are still areas for improvement in this article that we need to discuss together.

First, this study did not consider comparing enteric-coated and regular aspirin. Although Van Hecken et al. ² found that small-dose enteric-coated aspirin has similar antiplatelet effects as low-dose regular aspirin. However, other studies have shown that low-dose enteric-coated aspirin has low bioavailability and is not inhibited by platelet function. ³ Therefore, the application of enteric-coated aspirin may impact the research results. In addition, the surgical method, type of implant, and operation time of patients undergoing THA or TKA will have a particular impact on the occurrence of postoperative VTE. Zhang et al. ⁴ found that different surgical methods (surgical approach, implant type, operation time, with or without bone cement) have a great relationship with the occurrence of postoperative VTE. If this study counts and analyzes patients’ surgical information on the basis of previous studies, it will help improve the accuracy of the survey.

In this article, the authors want to further compare the effects of low-dose and high-dose aspirin on the incidence of postoperative VTE in patients, but there is still room for improvement. Patient’s postoperative out-of-bed time and activity level are closely related to the incidence of VTE. Talec et al. ⁵ suggested that early ambulation plays a significant role in preventing the occurrence of VTE. The study should consider the influence of each patient’s time out of bed and activity level on the results. Finally, we would like to thank the authors again for their contribution, which has dramatically helped recover patients undergoing arthroplasty and prevent VTE.