Pulmonary embolism in orthopaedic patients: diagnosis and management

Orthopaedic patients are at particularly high risk for pulmonary embolism. There has been a trend recently toward overdiagnosis of pulmonary embolism; thus, evaluation of the nature of a clinically relevant pulmonary embolism is needed, as is assessment of the timing, risks, and outcomes of therapeutic anticoagulation in surgical patients. Recent literature shows the incidence of pulmonary embolism to be increasing without a corresponding increase in mortality, suggesting that not all emboli may be clinically relevant and that increasingly sensitive tests may be picking up small emboli. The size and location of a clot or clots may matter when deciding on management. A risk-benefit evaluation can assist in deciding treatment.