Challenges of Anticoagulation in Total Joint Arthroplasty

Abstract

Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there are no guidelines for orthopaedic surgeons undertaking major primary and revision surgery in patients with high risk of venous thromboembolic events, who may present with complications directly linked to anticoagulant use. Hence the authors felt the need for this narrative review. They have tried to answer few questions that are commonly faced in clinical practice. Balanced anticoagulation is a difficult task to achieve. The potential consequences of over anticoagulation on the outcome of TJA and revision TJA are live changing and devastating. On the contrary falling short of adequate anticoagulation is fatal leading to recurrent thromboembolic events. Robust risk stratification tools and a multidisciplinary approach are certainly the way forward. There is an urgent need for specialty specific guidelines for managing patient on anticoagulation undergoing TJA, and revision arthroplasty procedures.

Anticoagulant therapy in orthopedic surgery – a review on anticoagulant agents, risk factors, monitoring, and current challenges

“…79,80 Also, it is difficult to establish the balance between the anticoagulant and bleeding complications. 81 Surgeons have cited bleeding as a prominent reason for not prescribing anticoagulants for at-risk surgical patients and for patients completing hospitalization following surgery. 78 Nonadherence to anticoagulant therapy is associated with increased hospitalizations and emergency visits.…”