Preoperative Management of Antithrombotics in Arthroplasty

Antithrombotic therapy is common in the arthroplasty patient population; the preoperative management of chronic antithrombotic medications requires coordination among the medical team. It is estimated that approximately 250,000 or 10% of patients on chronic antithrombotic medication undergo treatment interruption for surgical procedures annually in North America. Although the description of postoperative anticoagulation management after arthroplasty is extensive, orthopaedic literature describing the preoperative management of antithrombotic therapy is lacking. The goal of this guideline is to provide practicing orthopaedic surgeons concise recommendations for the preoperative management of common contemporary antithrombotics in the setting of elective arthroplasty using evidence-based guidelines from other medical specialties. All arthroplasty procedures are considered high bleeding risk in accordance with collaborative AAOS and ACC guidelines. Orthopaedic surgeons should collaborate with their colleagues in cardiology, anesthesia, and other specialties when planning perioperative antithrombotic interruption, particularly in the case of medically complex patients such as those with known risk factors for bleeding and clotting disorders. Resumption of antithrombotic therapy after arthroplasty is beyond the scope of this discussion; this should be performed in accordance with cardiology and anesthesia recommendations.