Joint replacement surgery is an effective treatment for severe arthritis. Most patients have a normal recovery following a joint replacement, but there are potential complications. One complication is the risk of developing blood clots after surgery.
Blood clots can develop in the deep veins of the body, typically in the legs. These clots are called deep venous thrombosis (DVTs) and can cause pain and swelling in the legs. In addition, a DVT can potentially break free from the veins in the legs, and travel through the bloodstream to the lungs. When this happens, the problem is called a pulmonary embolism (PE).
To help prevent blood clots after hip replacement and knee replacement, there are a number of steps that your surgeon will take. These may include getting you up and walking, exercises to stimulate blood flow, boots to squeeze the veins in your legs, and medications to prevent a clot in the blood. You will typically be given a blood thinning medication, also called an anticoagulant.
Making Sense of Blood Thinners for Surgery Patients
Blood Thinners Used After Surgery
The most commonly used options for blood thinning medications are oral or injected medications. These include:
Direct oral anticoagulants (DOACs): Although DOACs are newer than other common blood thinners, they've already been shown to be more safe, convenient, and effective. They've been recommended by the American Society of Hematology and other medical societies. DOACs that may be used after knee or hip replacement include:
Xarelto (rivaroxaban)
Pradaxa (dabigatran)
Eliquis (apixaban)
Savaysa (edoxaban)
Aspirin: This is considered an antiplatelet (not anticoagulant) medication—it prevents normal platelet function in the body. Platelets are cells in the blood involved in forming clots to stop bleeding—when platelet function is impaired, blood clots generally do not form. Aspirin is an appealing option because it is easy to take, inexpensive, and does not require monitoring of the blood.
Heparin-based medication, such as Lovenox (enoxaparin): Injections are often used because the level of blood thinning does not need to be checked with a daily blood test. The medication is given like an insulin shot, usually once a day. It is simple to perform but does require the patient to administer the shot once they have left the hospital.
Warfarin:Warfarin tablets are taken each evening. This medication gradually thins the blood but has different effects on different people. Therefore, blood tests must be done to ensure enough warfarin is given and that the blood is not too thin. The advantage of warfarin is that it is a simple way to thin blood and is more practical when needed for a longer time.
Anticoagulants After Hip or Knee Replacement Surgery
Guidelines for what medications to take after hip or knee replacement surgery generally vary by medical organization. Since their approval in 2010, DOACs have become common for blood clot prevention after knee or hip replacement surgery. Xarelto (rivaroxaban) has been studied most commonly.
Aspirin is another popular choice. Some studies have shown lower bleeding rates in people who took aspirin as compared to those who took DOACs. However, DOACs are still recommended over aspirin for people at high risk for blood clots, including those with cancer, chronic kidney disease, heart disease, obesity, or a history of blood clots.
A 2023 study following nearly 30,000 people after hip or knee replacement surgery emphasized the importance of tailoring the post-surgery treatment to the people's individual risks of blood clots.
How Long to Take Anticoagulants After Hip or Knee Replacement Surgery
There is no widespread agreement on the length of preventative treatment. You may need to continue treatment with blood thinners for at least two weeks and up to four weeks, depending on your individual risks.
In a review of studies about hip replacement surgeries, people took DOACs for 30–35 days after the surgery and antiplatelet medications like aspirin for 28–42 days after the surgery. The American Society of Hematology suggested extending preventive treatment to 19–42 days after the surgery.
Make sure to discuss your full medical history with your healthcare provider so they can prescribe the right medication and treatment length for you. Completing the full course of preventive treatment is essential even if you don't feel any bothersome symptoms.
Summary
To prevent blood clots after knee or hip replacement surgery, your healthcare provider will prescribe a blood thinning medication. You may need to take it for two to four weeks after the surgery. Commonly prescribed medications include direct oral anticoagulants (DOACs) such as Xarelto (rivaroxaban) and aspirin.
The type and length of treatment will vary based on your medical history and risk of blood clots. You may need to take blood thinners longer if you have medical conditions such as cancer or heart disease. Don't stop taking these medications without talking to your healthcare provider.
To prevent blood clots after knee or hip replacement surgery, your healthcare provider will prescribe a blood thinning medication. You may need to take it for two to four weeks after the surgery. Commonly prescribed medications include direct oral anticoagulants (DOACs) such as Xarelto (rivaroxaban) and aspirin.
Most people who have hip replacement surgery will take XARELTO® 10 mg once a day for 35 days following surgery. Those who have knee replacement surgery will usually take 10 mg once a day for 12 days. However, only your healthcare professional can decide how long you should take XARELTO®.
For example, after orthopedic surgery, people may need blood thinners for at least 10 to 14 days — and even up to 35 days. For other, more minor types of surgical procedures, you may be able to stop taking blood thinners once you go home and can walk around normally after surgery.
Duration of thromboprophylaxis: Although the optimal duration of thromboprophylaxis is not known for any orthopedic surgery group, extended prophylaxis for 14-35 days is recommended for patients undergoing hip and knee arthroplasty or hip fracture surgery.
Preventing and treating blood clots after hip and knee replacement surgery is an important part of your recovery. Joint replacement patients are at highest risk for developing a DVT two to 10 days after surgery, and remain at risk for approximately three months.
When you're inactive, blood flow in the deep veins slows down, which can lead to blood clots. High-risk blood clots appear within the first 3 months after surgery, as early as 2 to 10 days after surgery. Blood clots are more likely to form during or after surgery than in your daily life.
Take ELIQUIS exactly as prescribed by your doctor. ELIQUIS is taken by mouth twice daily. The recommended dose of ELIQUIS is 2.5 mg and the initial dose is usually taken 12 to 24 hours after surgery.
Indefinite anticoagulation is often chosen if there is a low risk of bleeding, whereas anticoagulation is usually stopped at 3 months if there is a high risk of bleeding.
It should usually be continued for 10–14 days if you have had surgery to replace your knee, and for 32–38 days if you have had surgery to replace your hip, to help prevent venous thromboembolism.
The ACCP Evidence-Based Clinical Practice Guidelines recommend discontinuing warfarin 5 days before a procedure to allow for INR lowering. In patients with an INR between 2.0 and 3.0, the INR has been shown to decrease to < 1.5 within 115 hours after withholding warfarin.
Initial treatment: For most DVT cases, blood thinners are typically taken for 3-6 months. Long-term management: After the initial phase, your doctor will assess your individual situation and determine if you need to continue taking blood thinners for a longer period, possibly for several years or even indefinitely.
Expert Analysis. Pulmonary embolism (PE) is a common medical condition affecting over 250,000 patients in the United States each year. For those patients diagnosed with PE in whom therapeutic anticoagulation is deemed appropriate, current guidelines recommend an initial treatment period of 3 months.
Blood Thinners: Patients who are at low risk for developing blood clots are typically placed on aspirin 325mg once daily for 6 weeks post op. Patients with bleeding risks may be placed on baby aspirin (81mg) instead.
The results of network meta-analysis showed that apixaban, edoxaban, fondaparinux, rivaroxaban, and darexaban were the most effective anticoagulants for the prevention of deep vein thrombosis in patients undergoing total hip or knee arthroplasty (P < .
Multiple studies have shown no benefits of using anticoagulation beyond 10–14 days in total knee replacement patients. For total hip replacement, many studies and guidelines recommend at least 4 weeks of anticoagulation.
Stopping blood thinners can increase your risk for blood clots, due to the underlying risk factor(s) for which your blood thinner was originally prescribed. Many times, these bleeding and clotting risks can be complicated for you to understand, and difficult for your healthcare providers to manage.
The mean intra-operative blood loss was 220 ml (±115.6) and the average post-operative drainage was 443 ml (±160.9). The total measured blood loss thus amounted to 663 ml (±209.7) in a primary uncomplicated TKR.
Hobby: LARPing, Kitesurfing, Sewing, Digital arts, Sand art, Gardening, Dance
Introduction: My name is Amb. Frankie Simonis, I am a hilarious, enchanting, energetic, cooperative, innocent, cute, joyous person who loves writing and wants to share my knowledge and understanding with you.
We notice you're using an ad blocker
Without advertising income, we can't keep making this site awesome for you.
:max_bytes(150000):strip_icc()/shot-56eb8efc5f9b581f34528cb0.jpg "How Long to Take Anticoagulants After Joint Replacement Surgery (1)")
