Key result
Intravenous iron therapy and tranexamic acid emerge as valuable strategies in minimizing transfusion requirements and optimizing outcomes in elderly patients on OAC undergoing orthopedic surgery.
Why the study?
Data on the peri-operative management of anemia in patients taking oral anticoagulants undergoing surgery are limited and often heterogeneous.
Intravenous iron therapy and tranexamic acid are valuable strategies for minimizing transfusion requirements in elderly patients on oral anticoagulants undergoing major orthopedic surgery.
Answers are grounded in this paper and cite their sources.
Limited data on peri-operative OAC management in anemic elderly; leaves open evidence-based protocols for major orthopedic surgery.
BACKGROUND: Elderly populations face an increased risk of anemia, leading to elevated transfusion requirements during surgery, especially major orthopedic procedures. Anemia itself increases the risk of thromboembolic events, thus compounding complications in elderly individuals. Polypharmacy and the prevalent use of oral anticoagulants (OAC), particularly for atrial fibrillation, contribute to bleeding risks in this population. Data available in the literature on the peri-operative management of anemia in patients taking OAC is limited and often heterogeneous. MATERIALS AND METHODS: This narrative case-based review focuses on the peri-operative management of elderly patients on OAC undergoing major orthopedic surgery. PubMed/Medline was used to search for relevant literature. RESULTS: With reference to two cases, we critically evaluate the literature, and focus on risk factors, and preventive and therapeutic strategies as fundamental tools to reduce bleeding and correct anemia as soon as possible in elderly patients undergoing major orthopedic surgery. DISCUSSION: Peri-operative management of these patients, especially those on OAC, requires a balanced approach considering bleeding and thrombotic risks. Intravenous iron therapy and tranexamic acid emerge as valuable strategies in minimizing transfusion requirements and optimizing patients' outcomes.
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Grandone et al. (2024) conducted a review in Elderly patients on oral anticoagulants undergoing major orthopedic surgery (n=2). Peri-operative management (intravenous iron therapy and tranexamic acid) was evaluated. Intravenous iron therapy and tranexamic acid emerge as valuable strategies in minimizing transfusion requirements and optimizing outcomes in elderly patients on OAC undergoing orthopedic surgery.
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