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.

Keywords: anticoagulation; arthroplasty; major bleeding; surgical complications; venous thromboembolism.

Figure 1

Algorithm for the perioperative interruption of antithrombotic agents. DOAC: direct oral anticoagulant. INR: international normalized ratio. BID: twice per day.