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DOS Kongressen 2017 ·
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Is discontinuation of vitamin-K-antagonist neces-
sary prior to elective TKA surgery?
Christian Skovgaard Nielsen, Henrik Husted , Kristian Stahl Otte, Thue Ørsnes ,
Anders Troelsen , Kirill Gromov
Departement for Orthopedic Surgery , Hvidovre Hospital
Background:
For patients undergoing Total Knee Arthroplasty (TKA) and si-
multaneously in anticoagulation treatment with vitamin-K antagonist (VAK), the
treatment is usually discontinued prior to surgery. However, studies have shown
high frequency of thromboembolic (TE) complications with discontinued VAK.
Purpose / Aim of Study:
Thus, aim of this study was to describe intraopera-
tive, 24 h calculated total blood loss (TBL) and complications for primary TKA
without discontinuing VAK.
Materials and Methods:
Eight consecutive patients undergoing TKA and in
VAK treatment were enrolled; 7 had unilateral TKA and 1 bilateral TKA. All 8
patients discontinued VAK, and all TKA were performed in a fast-track setup
without use of tourniquet. Patient demographics, intra-and postoperative data
plus complications within 90 days were recorded. TBL was calculated by Gross’
formula.
Findings / Results:
Seventy-five % were men, age and BMI were 73 y (IQR
68y-78y) and 31 (IQR 26-35), respectively, 63 % were ASA III and 6 patients
and high TE risk whereas 2 patients had low TE risk. Surgical time was 49 min
(IQR 44-55 min). All procedures were performed with International Normalized
Ratio (INR) in therapeutic range. Calculated TBL for unilateral TKA’s was 1273
ml (IQR 1141-1428 ml), intraoperative blood loss was 200 ml (IQR 100-200)
and 2 patients had blood transfusions, 1 and 2 units respectively. Length of stay
(LOS) was 3 days (IQR 2.8-4.3 days). The bilateral TKA had a TBL of 3029 ml.
No complications related to anticoagulation or surgery were recorded < 90 days.
Conclusions:
TKA without discontinuation of VAK might increase TBL slightly,
though; TBL was comparable to published data on patients without VAK. Con-
sidered the frequency of TE complications with paused VAK in high-risk pa-
tients, this descriptive study indicates a benefit of not discontinuing VAK for
TKA surgery.
No conflicts of interest reported
175.