Anticoagulation Strategies for the Orthopaedic Surgeon: Reversal and Timelines



1 Yale University Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven CT, USA

2 University of Miami Leonard M. Miller School of Medicine, Miami FL, USA

3 Department of Orthopaedic Surgery, St. Elizabeth Medical Center, Brighton MA, USA- Harvard Medical School, Boston, MA, USA


Article Highlights:
1) This article provides a full anticoagulant reference for the practicing orthopaedic surgeon which can be used in any clinical scenario, whether urgent or elective surgical intervention is required
2) A comprehensive list of anticoagulant reversal agents and drugs with short half-lives (for bridging) are described with the intention to provide the data needed to safely manage a patient peri-operatively during urgent orthopaedic surgical care (i.e. fracture or infection)
3) Half-life and method of excretion for all drugs are included with the intention to accurately guide decisions regarding the appropriate timing of scheduling elective orthopaedic surgical care with regards to anticoagulant metabolism and effect
4) The practicing orthopaedic surgeon using this guide should always consider medical co-management of these complex patients as their medical co-morbidities may not be amenable to anticoagulant reversal or peri-operative cessation of therapy, even for a short period
5) The data contained in this article stands to serve as a foundation upon which institution-specific guidelines regarding the peri-operative management of orthopedic patients on long-term anticoagulation can be developed