Anticoagulants

Anticoagulants

Prepared by Dr. Alper DUNKI

Anticoagulants are medications that prevent clot formation. They are essential in orthopaedics for thromboprophylaxis, especially after surgery.

Common Anticoagulants in Orthopaedics:

1. Low Molecular Weight Heparin (LMWH): Enoxaparin
2. Direct Oral Anticoagulants (DOACs): Rivaroxaban, Apixaban, Dabigatran
3. Unfractionated Heparin
4. 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