Periprocedural Management of Chronically Anticoagulated Patients: A Practical Approach to Use of Novel Anticoagulants in Orthopedic Surgery.

Chronic anticoagulation is common in patients undergoing total joint arthroplasty (TJA). The newer novel oral anticoagulants dabigatran, rivaroxaban, and apixaban target individual factors in the clotting cascade (factors Xa, IIa). The stable pharmacokinetics of these medications provide improved efficacy and safety with equivalent or superior antithrombotic properties. There are no management guidelines for these newer anticoagulants in TJA. Understanding the pharmacokinetics, conventional laboratory tests, dosing, and reversal methods that can be used for coagulation hemostasis is crucial for surgeons who are deciding whether to operate now or later.