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

INTRODUCTION: A 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.

METHOD: A 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.

RESULTS: The 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.