Comparison of clinical outcomes of enoxaparin and aspirin for postoperative venous thromboembolism prophylaxis in hip fractures.

Authors

Oğuzhan Korkmaz, Ömer Serdar Hakyemez, Niyazi Çakır, Ardahan Özdenboyacı, İbrahim Uzunlu, Abdullah Demirtaş, İbrahim Azboy

Published in

Acta orthopaedica et traumatologica turcica. Volume 60. Issue 2. Mar 27, 2026. Epub Mar 27, 2026.

Abstract

The risk of symptomatic venous thromboembolism (VTE) following hip fracture surgery is estimated at 1%-6%, necessitating effective prophylactic measures. While aspirin has been widely used in total hip and knee arthroplasty due to its comparable efficacy, reduced bleeding risk, and cost-effectiveness, its role in trauma patients remains under researched. This study aims to evaluate the efficacy and safety of aspirin and enoxaparin for VTE prophylaxis in hip fracture patients.
This two-center, retrospective study analyzed 306 adult patients who underwent hip fracture surgery between 2019 and 2023. Patients were divided into 2 groups: the aspirin group (81 mg twice daily) and the enoxaparin group (40 mg subcutaneous once daily), both receiving prophylaxis for 4 weeks postoperatively. Demographics, comorbidities, surgical details, and clinical outcomes-including major bleeding events, symptomatic VTE (deep vein thrombosis and pulmonary embolism), periprosthetic joint infection (PJI), blood transfusion requirements, and 90-day mortality-were recorded. Statistical analyses were performed using Pearson chi-square and independent t-tests, with significance set at P < .05.
The aspirin group (n = 136) and enoxaparin group (n = 170) had mean ages of 67.66 Å} 19.67 and 63.42 Å} 19.71 years, respectively. Hemoglobin decrease was significantly lower in the aspirin group (1.75 Å} 1.07 g/dL vs. 2.73 Å} 1.56 g/dL, P = .001). In addition, the amount of postoperative blood transfusion was statistically significantly lower in the aspirin group compared to in the enoxaparin group (0.89 vs. 1.31 units, respectively, P = .034). There was no significant difference in mean hospital stay (6.84 vs. 6.65 days, P = .751). The incidence of major bleeding was higher in the enoxaparin group (3.7% (n = 5) vs. 5.3% (n = 9)), though not statistically significant (P = .789). Symptomatic VTE occurred in 3.7% (n = 5) of the aspirin group and 5.3% (n = 9) of the enoxaparin group (P = .453). Periprosthetic joint infection was observed in 2 patients in the enoxaparin group but none in the aspirin group (P = .447). Mortality within 90 days was lower in the aspirin group (8.8% (n = 12) vs. 15.9% (n = 27)), but the difference was not statistically significant (P = .066).
This study suggests that aspirin appears to be a reasonable alternative to enoxaparin for VTE prophylaxis in hip fracture patients, demonstrating comparable efficacy with a lower blood transfusion requirement and similar rates of major bleeding and symptomatic VTE. Given its affordability, ease of administration, and favorable safety profile, aspirin appears to be a reasonable and costeffective alternative for high-risk trauma patients.   Cite this article as: Korkmaz O, Hakyemez ÖS, Çakır N, et al. Comparison of clinical outcomes of enoxaparin and aspirin for postoperative venous thromboembolism prophylaxis in hip fractures. Acta Orthop Traumatol Turc. 2026; 60(2), 0305, doi: 10.5152/j.aott.2026.25305.

PMID:
42364203
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

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