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Perioperative Use of Novel Oral Anticoagulants in Orthopaedic Surgery

A Critical Analysis Review

Eliasberg, Claire D. MD1; Levack, Ashley E. MD, MAS1; Gausden, Elizabeth B. MD, MPH1; Garvin, Sean MD1; Russell, Linda A. MD1; Kelly, Anne M. MD1

doi: 10.2106/JBJS.RVW.18.00148
Review Articles with Critical Analysis Component

  • » The use of novel oral anticoagulants (NOACs) in the perioperative setting is an important issue that is particularly relevant to orthopaedic procedures, but no official recommendations currently exist for NOACs in orthopaedic surgery.
  • » Given the lack of a current consensus in the orthopaedic literature, a standardized approach is essential in order to help minimize both the duration of time without chronic anticoagulation and complications that can arise from excessive bleeding.
  • » We propose a combined profile assessment that takes into account the type of anticoagulant as well as both patient-specific and procedure-specific risk factors and provide an algorithm to help guide periprocedural NOAC use.

1Departments of Orthopaedic Surgery (C.D.E., A.E.L., E.B.G., and A.M.K.), Anesthesiology (S.G.), and Medicine (L.A.R.), Hospital for Special Surgery, New York, NY

E-mail address for C.D. Eliasberg:

Investigation performed at the Hospital for Special Surgery, New York, NY

Disclosure: This publication was supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) under award number T32 AR007281. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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