Anticoagulation Management in Geriatric Orthopedic Trauma Patients

Abstract

This article will review the perioperative management of geriatric patients on anticoagulants who present for non-elective orthopedic surgery. Our understanding of best practices in perioperative anticoagulation management has advanced significantly over the last 5 years. More patients are presenting for surgery on direct oral anticoagulants which require a different approach than the vitamin K antagonist, warfarin. We have come to better appreciate the importance of time to the operating room on outcomes, specifically in hip fracture surgery. Regional anesthesia now has standardized guidelines for preprocedure anticoagulation interruption. Prothrombin complex concentrate has increasing acceptance for warfarin reversal preoperatively. Reversal agents are now available for the direct oral anticoagulants but are not recommended for standard use preprocedure. And there has been a shift away from routine use of bridging anticoagulation periprocedure. A team-based approach with input from the surgical, anesthesia, and internal medicine or geriatric team preoperatively is critical to the management of perioperative anticoagulation.