Practical Management of Anticoagulants in Family Medicine After Orthopedic Surgery

In order to prevent postoperative venous thromboembolism, prophylactic anticoagulant therapy is routinely administered to hospitalized patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, after hospital discharge, anticoagulant therapy is primarily managed by a primary care physician (PCP). The agents traditionally used for this purpose are associated with certain limitations that affect anticoagulation management. The new, fixed-dose oral anticoagulants have predictable pharmacokinetic and pharmacodynamic profiles, no requirement for coagulation monitoring, and a low propensity for food and drug interactions. As a result, they have the potential to simplify and improve postoperative outcomes in patients who have undergone THA or TKA and allow for simpler management of anticoagulation in these patients. This article examines the clinical evidence for benefits of the new oral anticoagulants, discusses caveats regarding their appropriate use, and provides some guidance regarding bleeding management with these agents.