title: Preoperative Versus Postoperative Initiation of Warfarin Therapy in Patients Undergoing Total Hip and Knee Arthroplasty.
abstract: The optimal strategy for postoperative deep venous thrombosis prophylaxis remains controversial in hip and knee arthroplasty. Warfarin causes transient hypercoagulability; however, the optimal timing of treatment remains unclear. We evaluated the effects of preoperative versus postoperative warfarin therapy with a primary endpoint of perioperative change in hemoglobin. Warfarin was dosed according to a standard nomogram. No difference in perioperative hemoglobin change was observed. The preoperative group demonstrated higher INRs. Initiation of warfarin preoperatively was not associated with any difference in perioperative hemoglobin change. Larger studies are needed to determine whether the risk of adverse events is increased with either strategy.
authors.affiliation: Department of Orthopedics, Washington University in St Louis, St Louis, MO, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Cipriano
authors.affiliation: Department of Orthopedics, Naval Medical Center, Portsmouth, ME, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Erdle
authors.affiliation: Department of Orthopedics, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Li
authors.affiliation: OrthoCarolina, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA. Electronic address: bmcurt01@gmail.com.
authors.forename: Brian
authors.initials: B
authors.lastname: Curtin
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D006801:Humans; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D020246:Venous Thrombosis / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation; Dosing regimen; Perioperative blood loss; Warfarin