Blood Thinners After Joint Replacement Surgery

Joint replacement surgery is an effective treatment for severe arthritis. Most patients have a normal recovery following a joint replacement, but there are potential complications. One complication is the risk of developing blood clots after surgery.

Blood clots can develop in the deep veins of the body, typically in the legs. These clots are called deep venous thrombosis (or DVTs) and can cause pain and swelling in the legs. In addition, a DVT can potentially break free from the veins in the legs, and travel through the bloodstream to the lungs. When this happens, the problem is called a pulmonary embolism (or PE).

A PE is a serious medical condition that can lead to problems breathing and low oxygen levels in the bloodstream; in serious situations, a PE can be life threatening.

Patient recieving shot from nurse
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In order to prevent blood clots after hip replacement and knee replacement, a blood thinning medication, also called an anticoagulant, is typically given. There are a number of steps that your surgeon will take to help prevent blood clots. These steps may include getting you up and walking, exercises to stimulate blood flow, boots to squeeze the veins in your legs, and medications to prevent a clot in the blood.

Blood Thinners Used After Surgery

The optimal length of time to take blood-thinning medications has not been precisely established, but there are guidelines that can be followed. The length of time patients take an anticoagulation medication depends on the type of surgery, and the type of anticoagulation medication being used.

The most commonly used options for blood thinning medications are oral or injected medications. The injection is usually a heparin-based medication (e.g. Lovenox/enoxaprin); and there are a number of pill options.

  • Injections: Injections are often used because the level of blood thinning does not need to be checked with a daily blood test. The medication is given like an insulin shot, usually once a day. It is simple to perform but does require the patient to administer the shot once they have left the hospital.
  • Aspirin: Aspirin is a medication that prevents normal platelet function in the body. When platelet function is impaired, clots generally do not form. Aspirin is an excellent option because it is easy to take, inexpensive, and does not require monitoring of the blood.
  • Coumadin: Coumadin (warfarin) tablets are taken each evening. This medication gradually thins the blood, but it has different effects on different people. Therefore, blood tests must be done to ensure enough Coumadin is given, and that the blood is not too thin. The advantage of Coumadin is that it is a simple way to thin blood, and more practical when needed for a longer time.

Anticoagulants After Hip Replacement Surgery

Following hip replacement surgery, anticoagulation medication should be given for at least 10 to 14 days. The risk of a blood clot can be reduced by continuing blood-thinning medications for up to one month, according to some research published in 2007.

Anticoagulants After Knee Replacement Surgery

After knee replacement surgery, blood thinning medications should be given for at least 10 days. In contrast to hip replacement surgery, there has been no advantage in continuing these medications for a month.

Why You Shouldn't Prolong Unnecessary Use of Blood Thinners

Extending blood thinning medications longer than needed can open up the door for possible complications of having blood that is too thin.

These side-effects of anticoagulation medications include bleeding around the incision, or internal bleeding, such as a stomach ulcer or stroke. Risks of bleeding are small but need to be balanced against the possibility of developing a blood clot.

If the Healthcare Provider Suggests a Different Length of Time for Medication

These are guidelines that have been established and agreed upon by the American College of Chest Physicians and the American Academy of Orthopaedic Surgeons. That said, there are many individual factors that may lead to a change in the duration of these medications. For example, patients with pre-existing medical conditions, patients who develop a blood clot, or other high-risk patients may need to continue these medications for longer than the aforementioned guidelines.

You should follow your healthcare provider's recommendations for the length of time to continue blood thinning medications. If you have any questions about how long to continue anticoagulation medication, you should contact your practitioner.

1 Source
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  1. Friedman RJ. Optimal duration of prophylaxis for venous thromboembolism following total hip arthroplasty and total knee arthroplasty. J Am Acad Orthop Surg. 2007;15(3):148-55. doi:10.5435/00124635-200703000-00004

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.