Perioperative antithrombotic management in joint replacement surgeries

Abstract

531Objectives To determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries.Data sources MEDLINE and PubMed database search up to January 2013.Study selection Those dealing with perioperative antithrombotic management of patients undergoing orthopaedic operations, especially joint replacement, and also those undergoing general surgery. Various combinations of the following key words were used in our search: "antiplatelet", "antithrombotic", "anticoagulant", "coronary stent", "perioperative", "venous thromboembolism", "cardiovascular", "surgery", "orthopaedic", "knee replacement", "hip replacement", "joint replacement", and "arthroplasty". Data extraction Literature review, original articles, and best practice guidelines.Data synthesis Patients should be stratified according to their risk of developing arterial thromboembolism in order to decide the most appropriate perioperative antiplatelet or anticoagulant regimen for them. After recent coronary stenting, including bare-metal stents implanted within 6 weeks and drug-eluting stents implanted within 6 months, surgery should be deferred. For venous thromboembolism prophylaxis in patients already on aspirin, the dosage should be adjusted as necessary or additional low-molecular-weight heparin administered. ConclusionThe perioperative management of patients with cardiac diseases in receipt of antithrombotic agents is based upon a delicate balance between the perceived risk of arterial thromboembolism and the perceived risk of perioperative bleeding. One must exercise good judgement in deciding the most appropriate perioperative antithrombotic regimen. Venous thromboembolism is also a common problem after joint replacement surgeries. For patients already on aspirin, optimal venous thromboembolism prophylaxis is still being debated.Perioperative antithrombotic management in joint replacement surgeries R E V I E W A R T I C L E

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

“…There is a distinct proof that elective surgeries like TKA should be avoided (if it’s possible) within the first year of stent implantation, as it’s been reported a 5- to 10-fold increase in acute stent thrombosis[45]. Of course, after the first year most of these patients continue with single antiplatelet therapy[46]. …”

THA and TKA in patients with cardiovascular disease: What makes the risk of perioperative bleeding?

“…Given the signifi cantly higher incidence of bleeding complications and insignifi cant difference in the incidence of ischaemic complications in patients after THA or TKA compared to patients after other orthopaedic procedures, we can ask whether consistent perioperative anticoagulation prophylaxis in patients with arthroplasty may be the reason for the reduced incidence of ischaemic complications or the cause of increased incidence of bleeding complications (4,5,7,12,15,16). We cannot answer this speculative question based on the results achieved in our study.…”

“…These complications may have an important impact on the result of surgery and quality of life (1)(2)(3)(4)(5)(6)(7). The development of such complications is infl uenced by a number of known factors such as age, weight, history of cardiac or vascular diseases, antithrombotic medication in the preoperative period, hypercoagulable state (1,5,8,9).…”

Daily blood loss transition after total knee arthroplasty with topical administration of tranexamic acid: Paradoxical blood loss after action of tranexamic acid

“…However, there was an enough period for washing out of the effect of anticoagulants. 18 Furthermore, the proportions of patients using anticoagulants preoperatively were not different between the TXA and the non-TXA groups. Finally, the mechanism of our findings was not determined.…”

“…Anticoagulant drugs, if taken, were stopped at 1 week prior to surgery for washing out the drug effect. 18 Postoperatively, all patients took chemical thromboembolic aspirin (150 mg once daily) prophylactically for 10 days. 19 The patients who had taken anticoagulants before surgery took drugs that were previously used after chemical thromboembolic prophylaxis.…”