• Hong Kong Med J · Dec 2013

    Review

    Perioperative antithrombotic management in joint replacement surgeries.

    • H L Lee, K Y Chiu, K H Yiu, F Y Ng, C H Yan, and P K Chan.
    • Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
    • Hong Kong Med J. 2013 Dec 1; 19 (6): 531-8.

    ObjectivesTo determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries.Data SourcesMEDLINE and PubMed database search up to January 2013.Study SelectionThose dealing with perioperative antithrombotic management of patients undergoing orthopaedic operations, especially joint replacement, and also those undergoing general surgery. Various combinations of the following key words were used in our search: "antiplatelet", "antithrombotic", "anticoagulant", "coronary stent", "perioperative", "venous thromboembolism", "cardiovascular", "surgery", "orthopaedic", "knee replacement", "hip replacement", "joint replacement", and "arthroplasty".Data ExtractionLiterature review, original articles, and best practice guidelines.Data SynthesisPatients should be stratified according to their risk of developing arterial thromboembolism in order to decide the most appropriate perioperative antiplatelet or anticoagulant regimen for them. After recent coronary stenting, including bare-metal stents implanted within 6 weeks and drug-eluting stents implanted within 6 months, surgery should be deferred. For venous thromboembolism prophylaxis in patients already on aspirin, the dosage should be adjusted as necessary or additional low-molecular-weight heparin administered.ConclusionThe perioperative management of patients with cardiac diseases in receipt of antithrombotic agents is based upon a delicate balance between the perceived risk of arterial thromboembolism and the perceived risk of perioperative bleeding. One must exercise good judgement in deciding the most appropriate perioperative antithrombotic regimen. Venous thromboembolism is also a common problem after joint replacement surgeries. For patients already on aspirin, optimal venous thromboembolism prophylaxis is still being debated.

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