Pulmonary Embolus
Prevention Therapy

Discussion for Pulmonary Embolus Prevention Therapy

Prevention of pulmonary embolus (PE) in total joint replacement surgery is of the utmost importance. It is also very important to balance the treatment for prevention against untoward events and complications associated with such treatment. Recently, low molecular weight heparin has come under great scrutiny because its industry “paid for” research. Their findings showed a reduction of deep venous thrombosis yet failed to show reduction in pulmonary embolus below other protocols such as aspirin, rapid mobilization, and external pneumatic compression devices. As discussed, there has to be a stratification of risk factors between the effects of a medication in preventing PE’s weighted against risk factors for PE’s reverse induced pharmacologic complications associated with over aggressive anticoagulation regimes.

I along with a group of renowned fellowship trained orthopedic surgeons in Houston have recently completed a review of the literature regarding prevention of pulmonary embolus in total joint replacement surgery. An extensive review of the world literature, by the American Academy of Orthopedic Surgeons along with several other subspecialty groups including the Knee Society, the American Association of Hip and Knee Surgeons, and numerous medical schools now feel that, an aspirin protocol is more beneficial in preventing pulmonary embolus while not creating detrimental effects of excessive bleeding following total joint replacements. Though we can never completely prevent PE’s, we can certainly tailor your care to minimize the risks while not exposing you to complications of unmonitored excessive blood thinners. It is the opinion of our consortium and the AAOS that aspirin provides similar protection while minimizing adverse events associated with excessive bleeding such as infection, stiffness, and prolonged recovery. If as discussed, you have any misgivings between now and when surgery is performed, we would be more than happy to use a low molecular weight heparin or Coumadin to prevent clots. If, on the other hand, the aspirin pathway is satisfactory for you, we will plan to proceed with our recommended aspirin based pulmonary embolus prevention protocol as discussed.

For further information on other guidelines in numerous teaching institutions, please feel free to use the Web to logon to a more extensive meta-analysis by the American Academy of Orthopedic Surgeons and the accompanying bibliography. www.orthoinfo.aaos.org/. Click Patient Information/Joint Replacement/Deep Vein Thrombosis.