Perioperative bridging anticoagulation therapy in at-risk patients undergoing elective arthroplasty surgery

We investigated the efficacy and safety of a standardized periprocedural anticoagulation bridging regimen that was instituted for patients who were on long-term oral anticoagulation therapy and were admitted for elective lower limb arthroplasty. Over a 3-month period, from March to June 2007, 15 inpatients who required temporary interruption of oral anticoagulation therapy in order to undergo elective orthopedic surgery were included in the study. All patients had bridging anticoagulation therapy instituted as per a standardized hospital protocol adapted from a British Orthopaedic Association publication. Patients were followed up prospectively during their inpatient stay. One operation was canceled, and 1 operating theatre list was rescheduled to delay a procedure because of nonadherence to the protocol. There were 2 cases of excessive surgical wound bruising, which caused additional morbidity and delayed discharge. One patient died from a cause unrelated to anticoagulation. Lack of proper knowledge of the bridging therapy protocol and improper communication between the medication prescribing and dispensing staff were the most important areas of concern. Given our study results, we believe that patient information and staff education are the key elements in successful implementation of a perioperative bridging anticoagulation protocol in elective arthroplasty.