DOS 2018

DOS Kongressen 2018 · 249 Is discontinuation of vitamin-K antagonist necessary prior to elective TKA surgery? Christian Skovgaard Nielsen Department of Orthopedics , Copenhagen University Hospital, Hvidovre Background: For patients undergoing primary Total Knee Arthroplasty (TKA) and contemporary anticoagulation treatment (AK) with vitamin-K antagonist (VAK), studies have shown an unacceptable high frequency of thromboembolic (TE) complications with discontinued VAK, especially in patients requiring bridg- ing therapy. Purpose / Aim of Study: The aim of this descriptive study was to describe intraoperative, 24 h calculated total blood loss (TBL) and complications in pa- tients undergoing TKA without discontinuing VAK. Materials and Methods: Nine consecutive patients in VAK treatment were enrolled prior to primary TKA surgery. All were operated without VAK discon- tinuation in a fast-track setup without use of tourniquet. The results were de- scriptively compared to published TBL for non-VAK patients in an identical TKA setup. Findings / Results: Seventy-seven % were men, median age and BMI were 77 y (IQR 69y-80y) and 31 (IQR 26-35), respectively. Regarding TE risk, 7 patients had a CHADS score of 3 or higher (characterized as high risk of TE complications). Preoperatively measured International Normalized Ratio (INR) was 2,7 (IQR 2,5-2,9). Intraoperative blood loss and calculated TBL were 200 ml (100-200 ml) and 1219 ml (IQR 1053-1377 ml), respectively. One patient received blood transfusion. No complications related to anticoagulation or sur- gery within 90 days were recorded. Conclusions: Performing TKA without discontinuation of VAK might increase TBL slightly compared to primary TKA patients without VAK treatment, per- formed in an identical fast track setup (CS. Nielsen, JBJS 2016), with mean intra- operative blood loss and TBL of 200 ml (150-250ml) and 1017 ml (±519ml), respectively. However, considered the frequency of TE complications with dis- continued VAK for high-risk patients, this descriptive study indicates a benefit of not discontinuing VAK for TKA surgery. 190.