Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Abstract

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

Thrombotic Disorders and Antithrombotic Treatments Special Issue

“…On the other hand, the association between inherited thrombophilia and thrombotic events is better studied for venous thromboembolism (VTE), and in this setting, the association between gene and environmental causes is well known. Environmental conditions that may predispose one to VTE, in fact, are also indicated as clinical conditions for which pharmacological thromboprophylaxis is always considered, and major orthopaedic surgery is one of them [4,5]. In the last few years, despite the application of international guidelines to prevent VTE after major orthopaedic surgery, the rate of thrombotic complications remained considerable.…”

“…In the last few years, despite the application of international guidelines to prevent VTE after major orthopaedic surgery, the rate of thrombotic complications remained considerable. Several drugs have been tested in this complicated scenario; in particular, subcutaneous injectable anti-Xa inhibitors as unfractionated heparin or low-molecular-weight heparin or fondaparinux and oral anti-Xa inhibitors as direct anticoagulants were tested and are now considered as prophylactic drugs both for elective major orthopaedic surgery and for sudden traumatic orthopaedic surgery [5]. Oral direct anticoagulants are actually the most commonly used drugs, not only for thromboprophylaxis after major orthopaedic surgery, but also in the long-term treatment of VTE.…”

What Are the Drivers of Readmission for Serious Venous Thromboembolic Events after Primary Total Knee Arthroplasty? An Analysis of 862,915 Patients

“…2,[5][6][7] This has drastically reduced the incidence of VTE after total joint arthroplasty. 2,5 Nevertheless, the American College of Chest Physicians (ACCP) estimates a baseline risk of 0.65 to 1.80% of symptomatic VTE episodes following TKA surgery with highrisk patients having an incidence of 4.30%. 1 Certain patient demographics and comorbidities have been linked to an increased occurrence of VTE after TKA.…”

“…[1][2][3][4] Given the substantial morbidity associated with VTE after major orthopaedic surgery, pharmacologic prophylaxis has become a standard of care to minimize the impact of VTE after total joint arthroplasty. 2,[5][6][7] This has drastically reduced the incidence of VTE after total joint arthroplasty. 2,5 Nevertheless, the American College of Chest Physicians (ACCP) estimates a baseline risk of 0.65 to 1.80% of symptomatic VTE episodes following TKA surgery with highrisk patients having an incidence of 4.30%.…”

Emergency Use of a Custom Distal Femoral Replacement System for Acute Periprosthetic Fracture with Catastrophic Implant Failure

“…T otal knee arthroplasty (TKA) is a highly successful procedure, yet 28% of patients require revisions in 25 years [1][2][3][4][5] . Young TKA patients (<55 years) exhibit even higher rates of aseptic revision, infection, extensor mechanism complications, early reoperation, and rerevision vs. older counterparts 6 .…”