Preoperative Versus Postoperative Initiation of Warfarin Therapy in Patients Undergoing Total Hip and Knee Arthroplasty

Cara Cipriano, Nicholas Erdle, Kai Li, Brian Curtin

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
Pages (from-to)9-13
Number of pages5
JournalOrthopedic Clinics of North America
Volume48
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • Anticoagulation
  • Dosing regimen
  • Perioperative blood loss
  • Warfarin

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