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Pulmonary embolism in total joint arthroplasty
L D Wolf1, W J Hozack, R H Rothman
1Thomas Jefferson University, Philadelphia, Pennsylvania.
Clinical Orthopaedics and Related Research
|March 1, 1993
Summary
Fatal pulmonary embolism after joint replacement surgery is preventable. Early detection of asymptomatic emboli using lung scans and prompt treatment with low-dose coumadin significantly reduces risks.
Area of Science:
- Orthopedic Surgery
- Cardiovascular Medicine
- Diagnostic Imaging
Background:
- Fatal pulmonary embolism (PE) incidence has decreased post-total joint arthroplasty due to improved thromboembolic complication prevention.
- Knowledge gaps exist regarding the natural history of symptomatic and asymptomatic PE.
- Optimal prophylactic agents for PE remain under investigation.
Purpose of the Study:
- To investigate the natural history of pulmonary embolism following total joint arthroplasty.
- To evaluate diagnostic tools for detecting pulmonary embolism.
- To assess the efficacy of prophylactic agents in preventing thromboembolic complications.
Main Methods:
- Review of existing literature on thromboembolic complications after total joint arthroplasty.
- Analysis of the diagnostic utility of serial lung scanning for PE.
- Evaluation of pulmonary angiography in diagnosing PE.
- Assessment of low-dose coumadin's effectiveness in PE prevention.
Main Results:
- Fatal pulmonary emboli are a preventable complication of total joint arthroplasty.
- Asymptomatic emboli frequently precede fatal events.
- Serial lung scans and pulmonary angiography aid in detecting and managing asymptomatic PE.
- Low-dose coumadin demonstrated effectiveness in reducing PE risk.
Conclusions:
- Fatal PE is preventable in total joint arthroplasty patients.
- Early detection and treatment of asymptomatic emboli are crucial.
- Low-dose coumadin is an effective agent for preventing various forms of PE.