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Joint replacement surgery is recognized as high risk bleeding operation. Hence the perioperative management of antithrombotic and anti-rheumatic drug is very important in order to balance postoperative bleeding, thromboembolic risk and risk of prosthetic joint infection. Antithrombotic drug consists of anticoagulant and antiplatelet. In the first step, physician has to evaluate thromboembolic risk in case patients have to stop taking antithrombotic drug. Physician should advise patients who take anticoagulant warfarin to stop taking it for 4-5 days before operating a surgery. However, for high thromboembolic risk patients, they should take bridging therapy in order to reduce thromboembolic effect. For patients who take direct oral anticoagulant (DOAC), they should stop taking DOAC for 3-4 days before surgery; there is no necessity to provide bridging therapy. For patients who take antiplatelet drugs, they should stop taking it for 5-7 days prior to surgery. Next step is to resume taking antithrombotic drug after operation when bleeding risk has diminished. Anti-rheumatic drug especially biological agents have a tendency to increase risk of infection after surgery, thus a very good plan in drug dosing cycle must be aligned with surgery schedule. After surgery for 14 days, patients should resume taking biological anti-rheumatic agents in case there are no surgical site infection, systemic infection, and wound healing problem.
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