Management of Chronic Antithrombotic Medication in Total Joint Arthroplasty: A Primer for the Orthopaedic Surgeon.

Abstract

The increasing prevalence of chronic antithrombotic medication use among aging and medically complex total joint arthroplasty (TJA) patients poses major challenges, requiring a careful balance of thrombotic and bleeding risks. This review aimed to summarize existing guidelines and supporting literature surrounding the perioperative management of chronic antithrombotics in patients undergoing TJA and identify remaining gaps and challenges to guide future research efforts. Current guidelines strongly recommend continuing aspirin throughout the perioperative period for TJA patients while advising the cessation of P2Y12 inhibitors and anticoagulants preoperatively, with specific timing dependent on patient- and procedure-related risks. There remains a critical gap in high-quality evidence and standardized guidelines regarding optimal postoperative resumption of chronic antithrombotics, leading to wide variability in practices and reliance on surgeon judgment. Future research efforts should prioritize developing evidence-based perioperative protocols tailored specifically for TJA patients on chronic antithrombotic therapy, similar to existing multidisciplinary guidelines for immunosuppressive management.