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Outcomes of different perioperative management strategies of patients on chronic anticoagulation in elective total
Diana Andronic1, Octavian Andronic2, Elias Ammann3
1School of Allied Health, Faculty of Health, Education, Medicine & Social Care ARU, Cambridge, United Kingdom.
Family Practice
|April 19, 2024
Summary
Managing anticoagulation for patients undergoing hip or knee replacement surgery is complex. Different perioperative strategies yield varied outcomes, with individualized risk assessment and multi-modal prophylaxis showing promise for minimizing complications.
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Guidelines for managing patients on long-term anticoagulation undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) vary.
- Discontinuing and restarting anticoagulation post-surgery presents challenges for healthcare providers.
Purpose of the Study:
- To systematically review perioperative anticoagulation management strategies for patients undergoing elective arthroplasty.
- To evaluate the impact of different anticoagulation protocols on postoperative complications.
Main Methods:
- Systematic review following PRISMA guidelines, searching PubMed/MEDLINE, EMBASE, and Web of Science.
- Inclusion of six retrospective studies (727 patients on therapeutic anticoagulation vs. 1,540 controls).
- Risk of bias assessment using Methodological Index for Non-Randomized Studies (MINORS) criteria.
Main Results:
- Studies evaluated warfarin vs. prophylactic anticoagulation (warfarin, aspirin, LMWH, UFH).
- Outcomes varied, with some studies reporting no significant difference in complications.
- Three studies indicated significantly higher rates of wound infections, revision surgeries, hematomas, and prosthetic joint infections (PJI) with certain protocols.
Conclusions:
- Perioperative anticoagulation management significantly impacts outcomes in elective arthroplasty patients on chronic anticoagulation.
- Evidence on the necessity of discontinuing therapeutic warfarin is contradictory.
- Individualized risk stratification combined with multi-modal prophylaxis appears to minimize complications.
