The patient population undergoing total hip arthroplasty and total knee arthroplasty is characterized by a high prevalence of cardiovascular diseases; however, antihypertensive therapy is suboptimal in a subset of patients, many patients with hypercholesterolemia do not receive statins despite clear indications, and many patients take antiplatelet agents without appropriate indications.
The study population scheduled for major orthopedic surgery had a high prevalence of cardiovascular disease and excess body weight.
A substantial proportion of hypertensive patients awaiting orthopedic surgery had untreated or inadequately controlled hypertension prior to hospitalization.
A large proportion of patients were taking antiplatelet agents, and nearly two-thirds of those taking antiplatelet therapy had no appropriate clinical indication for such treatment.
A significant number of patients were regularly taking anticoagulants prior to major orthopedic surgery.
Many patients with hypercholesterolemia were not receiving statin therapy despite having clear clinical indications for it.
This research examined the heart and blood pressure medications being taken by 1,733 patients in Russia who were scheduled to undergo elective hip or knee replacement surgery. The study found that the vast majority of these patients had significant cardiovascular risk factors: over 90% were overweight and about 78% had high blood pressure or other heart-related conditions. However, many of these patients were not receiving appropriate medical treatment — about 10% of those with high blood pressure had never been prescribed any blood pressure medication, and nearly 22% were on treatment but still had blood pressure above target levels. Additionally, many patients who had high cholesterol were not receiving cholesterol-lowering drugs (statins) even though guidelines clearly recommend them. The study also found a concerning pattern of medication overuse: nearly one-third of all patients (31%) were regularly taking antiplatelet drugs (blood thinners like aspirin that reduce clotting), but about 20% of all patients in the study were taking these drugs without any recognized medical reason to do so. This is particularly relevant before surgery, as unnecessary blood thinners can increase the risk of surgical bleeding complications. About 15% of patients were also taking stronger anticoagulant medications. This research suggests that patients preparing for major joint replacement surgery often have poorly managed cardiovascular conditions — some are undertreated for high blood pressure and high cholesterol, while others are taking blood-thinning medications they may not need. These findings highlight an important opportunity for general practitioners and orthopedic teams to review patients' medications more carefully before surgery, both to reduce cardiovascular risk and to avoid unnecessary bleeding complications.
Okisheva E, Trushina O, Lychagin A, Fomin V. (2026). [Evaluation of drug therapy in patients before major orthopaedic surgery from the perspective of a general practitioner: a real-world study].. Terapevticheskii arkhiv. https://doi.org/10.26442/00403660.2026.08.203726