Introduction: The recent BOA blue book on blood conservation in elective orthopaedic surgery highlighted the need for blood saving strategies to be implemented. Perioperative management guidelines of oral anti-coagulation and anti-thrombosis medication have to date concentrated on warfarin use. Information and guidelines on aspirin usage in elective orthopaedics and its effects post operatively are limited.

Methods: Data was collected prospectively from 1936 patients who underwent 2024 primary unilateral total hip replacement in a single institution. All patients were treated with the same postoperative transfusion regime and thromboembolic prophylaxis. Preoperative medication, haemoglobin levels and patient demographics were recorded by a standard assessment. Post op transfusion requirements and haemoglobin levels were noted throughout the postoperative period.

Results: Multivariate analysis revealed that preoperative aspirin use was a significant independent predictor of postoperative transfusion requirement (p< 0.001).

Discussion: Expanding indications for the use of aspirin for primary and secondary cardiovascular disease prevention have meant that large numbers of our patients undergoing total hip replacement are concurrently taking the drug. With increasing and emerging evidence of the risks involved in blood transfusion, including vCJD transmission and immune related reactions coupled with reduced supplies of donor blood further measures to reduce transfusion requirement are needed. We recommend that in the absence of absolute contraindications to stopping aspirin therapy, it should be omitted for 1 week prior to total hip replacement.