title: Perioperative antithrombotic management in joint replacement surgeries.
abstract: OBJECTIVE
  To determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries.
  
  
  METHODS
  MEDLINE and PubMed database search up to January 2013.
  
  
  METHODS
  Those 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".
  
  
  METHODS
  Literature review, original articles, and best practice guidelines.
  
  
  RESULTS
  Patients 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: H L
authors.initials: HL
authors.lastname: Lee
authors.forename: K Y
authors.initials: KY
authors.lastname: Chiu
authors.forename: K H
authors.initials: KH
authors.lastname: Yiu
authors.forename: F Y
authors.initials: FY
authors.lastname: Ng
authors.forename: C H
authors.initials: CH
authors.lastname: Yan
authors.forename: P K
authors.initials: PK
authors.lastname: Chan
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D004305:Dose-Response Relationship, Drug; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006331:Heart Diseases / Q000503:physiopathology; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D012307:Risk Factors; D015607:Stents; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Arthroplasty, replacement, hip; Arthroplasty, replacement, knee; Heart diseases; Heparin, low-molecular-weight; Venous thromboembolism