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It is well documented that the risk of venous thromboembolism after orthopedic surgery is very high. ALL patients undergoing these surgeries are anticoagulated after surgery.
The thromboembolic risk profile is the primary determinant of whether bridge therapy with heparin or enoxaparin is necessary during the reversal of chronic anticoagulation pre-procedure. In all cases, the postoperative pharmacologic regimen must balance the risk of bleeding with the need for thromboembolic prophylaxis.
High risk procedures
Intermediate risk procedures
Low risk procedures
The risk of postoperative wound hemorrhage must be estimated to establish a safe protocol for postoperative resumption of anticoagulation.
Target INR for elective orthopedic procedures is <1.3. Warfarin is generally held for 5 days prior to surgery.
Perioperative Management of Chronic Anticoagulation in Orthopaedic Surgery. J Am Acad Orthop Surg, Vol 18, No 12, December 2010, 729-738.
Special thanks to Scott Ball, MD for his expert guidance.
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