title: Warfarin management in patients on continuous anticoagulation therapy undergoing total knee replacement.
abstract: We evaluated the safety and efficacy of total knee replacement in patients receiving continuous warfarin therapy. We identified 24 consecutive patients receiving long-term warfarin therapy who underwent total knee replacement between 2006 and 2008 and compared them with a group of age- and gender-matched patients not on long-term anticoagulation. Primary observations were changes in haemoglobin, transfusion rates and complications. Secondary observations were fluctuations in the international normalised ratio (INR) and post-operative range of movement. There was no significant difference between the two groups in pre- or post-operative haemoglobin, incidence of transfusion or incidence of post-operative complications. There were no surgical delays due to a high INR level. The mean change in INR during the peri-operative phase was minimal (mean 0.4; SD 0.7). There was no significant difference in the range of movement between the two groups after day two post-operatively. Current American College of Chest Physicians guidelines recommend bridging therapy for high-risk patients receiving oral anticoagulation and undergoing major orthopaedic procedures. We have shown that a safe alternative is to continue the steady-state warfarin peri-operatively in patients on long-term anticoagulation requiring total knee replacement.
authors: North Sydney Orthopaedic and Sports Medicine Centre, The Mater Clinic, Suite 2, 3 Gillies St Wollstonecraft, Sydney, New South Wales 2065, Australia.
authors: R
authors: R
authors: Chana
authors: L
authors: L
authors: Salmon
authors: A
authors: A
authors: Waller
authors: L
authors: L
authors: Pinczewski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001803:Blood Transfusion; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D019934:International Normalized Ratio; D007719:Knee Joint / Q000503:physiopathology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D016059:Range of Motion, Articular; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins; D014859:Warfarin