Clinical Consensus Statement: Perioperative Management of Prothrombotics, Antiplatelets, Anticoagulants, DMARDs and Biologics in Elective Podiatric Surgery.

introductionA substantial body of literature exists on the perioperative management of pharmacological agents specifically prothrombotic agents, antiplatelets, anticoagulants and disease-modifying antirheumatic drugs (DMARDs) aimed at mitigating risks associated with both the medications themselves and the comorbidities they treat. However, a clear and consistent consensus on best practice is either lacking or poorly defined especially in foot surgery. To address this gap, a working group of podiatric surgeons convened to develop a Clinical Consensus Statement (CCS) for the perioperative management of these drugs in foot and ankle surgery.

methodA five-member panel identified four key areas of interest: prothrombotic agents, antiplatelets, anticoagulants and disease-modifying antirheumatic drugs. They conducted a comprehensive literature review to assess the available data and identify evidence gaps, ultimately formulating nineteen questions grouped within these areas using a modified Delphi method. These questions were presented to delegates at the 2022 Faculty of Podiatric Surgery (FoPS) Conference.

resultsThe recommendations from the clinical consensus statement are summarised in Appendix 1 highlighting the strength of each recommendation. Although more high-level evidence is needed to inform decision-making in this area, this consensus statement has utilised the available evidence base and reflects current practice. Rather than providing a definitive guideline, it provides valuable interim guidance for elective foot surgery, however, does not replace local trust policies and guidelines.