Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.

Published

Journal Article

This clinical practice guideline is based on a systematic review of published studies on the management of adult patients undergoing total hip replacement (THR) or total knee replacement (TKR) aimed specifically at preventing symptomatic pulmonary embolism (PE). The guideline emphasizes the need to assess the patient's risk for both PE and postoperative bleeding. Mechanical prophylaxis and early mobilization are recommended for all patients. Chemoprophylactic agents were evaluated using a systematic literature review. Forty-two studies met eligibility criteria, of which 23 included patients who had TKR and 25 included patients who had THR. The following statements summarize the recommendations for chemoprophylaxis: Patients at standard risk of both PE and major bleeding should be considered for aspirin, low-molecular-weight heparin (LMWH), synthetic pentasaccharides, or warfarin with an international normalized ratio (INR) goal of < or =2.0. Patients at elevated (above standard) risk of PE and at standard risk of major bleeding should be considered for LMWH, synthetic pentasaccharides, or warfarin with an INR goal of < or =2.0. Patients at standard risk of PE and at elevated (above standard) risk of major bleeding should be considered for aspirin, warfarin with an INR goal of < or =2.0, or none. Patients at elevated (above standard) risk of both PE and major bleeding should be considered for aspirin, warfarin with an INR goal of < or =2.0, or none.

Full Text

Duke Authors

Cited Authors

  • Johanson, NA; Lachiewicz, PF; Lieberman, JR; Lotke, PA; Parvizi, J; Pellegrini, V; Stringer, TA; Tornetta, P; Haralson, RH; Watters, WC

Published Date

  • March 2009

Published In

Volume / Issue

  • 17 / 3

Start / End Page

  • 183 - 196

PubMed ID

  • 19264711

Pubmed Central ID

  • 19264711

International Standard Serial Number (ISSN)

  • 1067-151X

Digital Object Identifier (DOI)

  • 10.5435/00124635-200903000-00007

Language

  • eng

Conference Location

  • United States