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Perioperative antithrombotic management in joint replacement surgeries
1Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Hong Kong Medical Journal = Xianggang Yi Xue Za Zhi
|October 22, 2013
Summary
Optimal perioperative antithrombotic management for cardiac patients undergoing joint replacement surgery requires balancing arterial and bleeding risks. Stratify patients by arterial thromboembolism risk to guide antiplatelet or anticoagulant therapy decisions.
Area of Science:
- Cardiology
- Orthopaedic Surgery
- Pharmacology
Background:
- Patients with cardiac diseases often require antithrombotic agents.
- Joint replacement surgery poses risks of arterial and venous thromboembolism.
- Perioperative management requires careful consideration of antithrombotic therapy.
Purpose of the Study:
- To determine optimal perioperative antithrombotic management strategies.
- To guide the use of antiplatelet and anticoagulant agents in cardiac patients undergoing joint replacement.
- To review current evidence on managing thromboembolic risks in this population.
Main Methods:
- Comprehensive literature search of MEDLINE and PubMed databases up to January 2013.
- Inclusion of studies on perioperative antithrombotic management in orthopaedic and general surgery.
- Review of original articles and best practice guidelines.
Main Results:
- Stratify patients by arterial thromboembolism risk to select appropriate perioperative regimens.
- Defer surgery for 6 weeks after bare-metal stenting and 6 months after drug-eluting stenting.
- Adjust aspirin dosage or add low-molecular-weight heparin for venous thromboembolism prophylaxis.
Conclusions:
- Perioperative management involves balancing arterial thromboembolism risk against bleeding risk.
- Judicious selection of antithrombotic regimens is crucial.
- Optimal venous thromboembolism prophylaxis for patients on aspirin remains under debate.
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