What to do with anticoagulation around the time of arthroplasty? Guidelines for perioperative management tend to recommend discontinuation of warfarin preoperatively in low risk patients. In a small, recently published study, researchers assessed a hypothesis that patients who continued warfarin during the perioperative period could have shorter hospital stay without a significant increase risk of surgical complications, compared to cases where warfarin was held. Caution is required in the interpretation of the study, which was a small retrospective review of 20 consecutive patients receiving long-term warfarin who underwent total hip replacement without stopping warfarin (compared to 20 patients matched for age and gender) where warfarin was held before to surgery and restarted after the procedure.The mean drop in haemoglobin after surgery was 25.95 g/L in the continuation group and 35.7 g/L in the control group (p = 0.0066). The mean length of hospital stay was shorter where warfarin group was continued (p = 0.0447), but the odds ratio for developing a postoperative complication was 1.5882 which was not statistically significant (p = 0.6346). Interpret conservatively, further validation is needed before this practice is widely adopted. See more details here