Hypercoagulable Disorders in Orthopaedics: Etiology, Considerations, and Management

Area of Science:

• Hematology
• Vascular Surgery
• Thrombosis Research

Background:

• Hypercoagulable disorders (HCDs), both inherited and acquired, elevate the risk of venous thromboembolic events (VTEs).
• Diagnosis of HCDs frequently occurs postoperatively due to surgical complications, highlighting a gap in proactive identification.
• The use of tourniquets in orthopedic surgery for patients with HCDs remains poorly understood and debated.

Purpose of the Study:

• To review the implications of hypercoagulable disorders in surgical patients.
• To provide recommendations regarding tourniquet use in orthopedic surgery for patients with known or suspected HCDs.

Main Methods:

• Literature review and clinical consensus on hypercoagulable disorders and surgical management.
• Analysis of existing data and case reports concerning tourniquet application in patients with thrombotic tendencies.

Main Results:

• Hypercoagulable disorders significantly increase the risk of VTEs, often identified after surgical procedures.
• Tourniquet use in patients with HCDs is associated with potential complications and requires careful consideration.
• Proactive hematological consultation is crucial for patients with known or suspected HCDs.

Conclusions:

• Referral to hematological specialists is recommended for HCD workup and management.
• Tourniquets should be avoided in surgical settings for patients with HCDs whenever feasible.
• Vigilant postoperative monitoring is essential for patients undergoing surgery with tourniquets, especially when HCD status is uncertain.