Anticoagulants
Anticoagulants are medications that prevent clot formation. They are essential in orthopaedics for thromboprophylaxis, especially after surgery.
Common Anticoagulants in Orthopaedics:
Low Molecular Weight Heparin (LMWH): Enoxaparin
Direct Oral Anticoagulants (DOACs): Rivaroxaban, Apixaban, Dabigatran
Unfractionated Heparin
Warfarin (less common due to monitoring needs)
Indications in Orthopaedics:
Prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) after joint replacement or major trauma
Management of patients with a history of thromboembolism
Atrial fibrillation with orthopaedic comorbidities
Key Considerations:
Start prophylaxis 6–12 hours after surgery (depending on bleeding risk)
Continue for at least 10–14 days, sometimes up to 35 days in hip replacement
Adjust dosing for renal function
Monitor for signs of bleeding (wound hematoma, prolonged bleeding)
Contraindications:
Active bleeding
Severe bleeding risk (e.g., recent CNS surgery)
Coagulopathy
Bridging and Reversal:
Reversal agents: Protamine (heparin), Vitamin K (warfarin), Idarucizumab (dabigatran)
Bridging required with LMWH in warfarin patients undergoing surgery