Treatment of early symptomatic pulmonary embolism after total joint arthroplasty

The purpose of this study was to evaluate the risk of intravenous heparin therapy or the use of Greenfield filters (Meditech, Watertown, MA) in the early postoperative period in patients who have documented symptomatic pulmonary embolism. Symptomatic pulmonary embolism in the first weeks was identified in 52 patients. Twenty-four patients were treated with Greenfield filter insertion and 28 patients with intravenous heparin therapy. One complication associated with insertion of the Greenfield filter-premature opening in the internal jugular vein-resulted in no adverse consequences. Three complications were associated with intravenous heparin therapy: one transient thrombocytopenia, one recurrent symptomatic pulmonary embolism, and one knee hematoma, which did not require surgical evacuation. It appears that Greenfield filter insertion is a viable option for treatment of symptomatic pulmonary embolism in the early postoperative period after total joint arthroplasty. In contrast to other published data, this study suggests that intravenous heparin therapy may also be a reasonable alternative, but is a treatment regimen that requires careful monitoring of platelets, wound complications, and bleeding parameters.