How Long Should Anticoagulants Be Stopped Before Knee Replacement? - Cardiology

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When preparing for knee replacement surgery, particularly in patients with a mechanical heart valve who are on anticoagulants, careful management of anticoagulation therapy is crucial. In your mother's case, the orthopedic surgeon has advised stopping anticoagulants eight days prior to the surgery, which is a common practice. The INR (International Normalized Ratio) value of 1.27 indicates that her blood coagulation is within a safe range, but it is essential to monitor this closely.

Typically, the duration for stopping anticoagulants before surgery can vary based on the type of anticoagulant being used, the patient's individual risk factors for thrombosis, and the type of surgery being performed. For patients on warfarin, it is generally recommended to stop the medication about 5 days before surgery to allow the INR to return to a safe level (usually below 1.5). However, in cases where there is a higher risk of thrombosis, such as in patients with mechanical heart valves, bridging therapy with low molecular weight heparin (LMWH) or unfractionated heparin may be employed. This involves starting heparin injections shortly after stopping the oral anticoagulant to prevent clot formation.

Stopping anticoagulants for too long can indeed pose risks, particularly for patients with mechanical heart valves, as they are at a higher risk for thromboembolic events (blood clots). Therefore, it is crucial to have a coordinated approach involving both the orthopedic surgeon and the cardiologist. The cardiologist can help determine the appropriate timing for resuming anticoagulation post-surgery, as well as whether bridging therapy is necessary.

In terms of safety, the decision to stop anticoagulants should always be made with a thorough understanding of the patient's overall health, the risks associated with their specific condition, and the nature of the upcoming surgery. It is important to communicate any concerns regarding the duration of anticoagulant cessation with the healthcare team, who can provide tailored advice based on your mother's medical history and current health status.

In summary, while stopping anticoagulants is necessary before knee replacement surgery, it should be done under careful supervision to balance the risks of bleeding during surgery and the risks of thrombosis. Regular follow-ups and communication with both the orthopedic and cardiology teams are essential to ensure a safe surgical outcome and optimal recovery.