Thromboprophylaxis and Perioperative Management of Chronic Anticoagulation in Patients Undergoing Total Hip and Knee Arthroplasty

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are elective procedures that restore quality of life to patients experiencing pain and/or immobility of end stage osteoarthritis, post-traumatic arthritis, or rheumatoid arthritis. Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and is a known complication after joint arthroplasty. Orthopaedic surgeons are as concerned with the complications of postoperative bleeding as they are with the high risk of thrombosis after arthroplasty. Risk stratification allows for patient-specific regimens and has proven to offer both safety and efficacy for thromboprophylaxis, leading to excellent patient outcomes. For patients taking chronic anticoagulants and antiplatelet agents, evidence-based guidelines provide added safety with respect to perioperative management of these medications. Together, surgeons, anesthesiologists, hospitalists, nurses, orthopaedic physician assistants, physical and occupational therapists plus a clinical pharmacy specialist can tailor a medication regimen and discharge plan which is patient-specific, integrating medical evidence with standardized practice.