Anti coagulation post surgery

[ibuputih]

11 years ago, just before all this AF malarkey started, I had a total knee replacement. After surgery I had to self inject Fragmin for about 14 days.

Other knee has recently failed spectacularly and I am due to have ‘TKR - the sequel’ next month with same surgeon. He is aware of AF and nearer the time I will have Pre-op exam plus he has requested a cardiac check too. I will have a chance to ask this question then, but I am impatient and wonder what others’ experience has been in similar situations …

I take Edoxaban and realise that I will be instructed to stop this before surgery - but I want to know what happens post surgery? Do Fragmin jabs do the anti coag business for a period of time and then, when the Fragmin medication regime stops, I resume with my usual Edoxaban? I’m intrigued.

[BobD Volunteer]

It is really up to the surgeon concerned but generally one would stop anticoagulation a few days before the surgery and start again a day or so afterwards. One should not try second guessing as hospital protocols differ.

[ibuputih in reply to BobD]

Thanks Bob - I get that, and I will find out shortly what my OS’s protocol will be.

Just me jumping the gun and wondering how it’s been dealt with for others.

[exmouth]

I had a knee replacement 3 years ago I just stopped Apixaban a couple of days before After surgery I had compression on my legs and then just started taking my usual dose.

[ibuputih]

Hi - thank you for replying.

From past experience I know that I will be wearing the dreaded TED stockings on both legs for 6 weeks - ugh. I was just intrigued how they merge post surgery anti coagulation and my usual dosage. I will find out soon!

[mogmeg in reply to ibuputih]

I had to stop taking my anti coagulation about 24 hours before if I remember rightly. The following day I had an injection to stop blood clots. Everyone else was sent home with these to administer themselves. Not sure how long for as I was told to continue with my medication, so wouldn't need these.

[ibuputih in reply to mogmeg]

Thanks for taking the time to reply. That’s interesting and makes sense - an initial jab then back to your normal regime.

[FraserB]

I recently had a total knee replacement (TKR) and I’m on Apixaban for AFl/AF. My surgeon instructed me to stop Apixaban 48 hours before surgery to reduce the risk of bleeding. After surgery, I resumed a lower dose of Apixaban (2.5 mg twice a day) in the hours post-op for 3 days, then returned to my regular dose of 5 mg twice a day. This helped balance clot prevention while minimizing bleeding. How a doctor prescribes post-surgical medications after TKR surgery is always tailored to your individual medical history.

In your case, the doctor is prescribing Fragmin, which is commonly used after surgery to prevent DVT and PE. The unique advantage of Fragmin is that it works quickly, which is beneficial in the immediate post-op period for preventing blood clots. Afterward, you will resume your usual Edoxaban regimen. Your doctor and the surgeon are well aware of the transitioning of these medications and have proven medical strategies in place to prevent a stroke, including the specific timing of the surgery (how long) and using bridge therapy like Fragmin plus closely monitoring your recover. The discussion you will have with your surgeon will give details.

The best with your second knee replacement—I’m glad I had mine done.

[ibuputih]

Hello - thank you for taking time with your detailed reply. I have a hunch that Fragmin may be used as a bridging therapy as you suggest.

Hope all is going well with your knee recovery and your ROM is increasing well. Can’t say I’m overjoyed at going through all that again - but at least I’ll have the summer to recover. Take care