Perioperative Anticoagulation in Hand Surgery: A Systematic Review.

Area of Science:

• Orthopedic Surgery
• Cardiovascular Medicine
• Pharmacology

Background:

• Antithrombotic medications (anticoagulants and antiplatelets) prevent thromboembolic events.
• Guidelines recommend stopping these therapies 3-5 days before surgery.
• Recent evidence questions this practice for certain procedures, suggesting continuation may be safe and beneficial.

Purpose of the Study:

• To review literature on continuing anticoagulation/antiplatelet therapy during hand and wrist surgery.
• To evaluate the impact on bleeding risks and thromboembolic events.

Main Methods:

• Systematic review of PubMed and Embase databases.
• Included 12 relevant studies after screening 149 results.
• Studies comprised prospective/retrospective cohorts and a case report.

Main Results:

• Continuing therapy generally did not significantly increase bleeding complications.
• Subcutaneous hematoma was the most common complication, managed non-surgically.
• Major hematomas were rare; one case reported pulmonary embolism after discontinuation.

Conclusions:

• Continuing antithrombotic therapy in hand surgery patients appears safer than interruption.
• Thromboembolic event risk may outweigh bleeding risk.
• Further research in larger cohorts is needed.