We suggest that patients discontinue antiplatelet agents (e.g., aspirin, clopidogrel) before undergoing elective hip or knee arthroplasty.

Rationale
Among non-arthroplasty surgical patients, preoperative antiplatelet use predicted higher perioperative blood loss in three studies of moderate to high quality. Reoperation rates due to bleeding only varied in one of the three studies (see Table 26 for a detailed presentation of these results, and Table 52 in Appendix XIII for our appraisal of the quality and applicability of these studies).

Although this evidence is not specific to elective hip or knee arthroplasty patients, the work group believed the evidence is still applicable to these patients who are at risk for bleeding and bleeding-associated complications.

We excluded some of the studies we retrieved to address this recommendation. These studies and the reasons for their exclusion are listed in Appendix XIV, Table 61.
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