We evaluated the safety and efficacy of total
knee replacement in patients receiving continuous warfarin therapy. We identified 24 consecutive patients receiving long-term warfarin
therapy who underwent total knee replacement between 2006 and 2008
and compared them with a group of age- and gender-matched patients
not on long-term anticoagulation. Primary observations were changes
in haemoglobin, transfusion rates and complications. Secondary observations
were fluctuations in the international normalised ratio (INR) and
post-operative range of movement. There was no significant difference between the two groups in
pre- or post-operative haemoglobin, incidence of transfusion or
incidence of post-operative complications. There were no surgical
delays due to a high INR level. The mean change in INR during the
peri-operative phase was minimal (mean 0.4; Current American College of Chest Physicians guidelines recommend
bridging therapy for high-risk patients receiving oral anticoagulation
and undergoing major orthopaedic procedures. We have shown that
a safe alternative is to continue the steady-state warfarin peri-operatively
in patients on long-term anticoagulation requiring total knee replacement.