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

Publication ,  Journal Article
Johanson, NA; Lachiewicz, PF; Lieberman, JR; Lotke, PA; Parvizi, J; Pellegrini, V; Stringer, TA; Tornetta, P; Haralson, RH; Watters, WC
Published in: J Am Acad Orthop Surg
March 2009

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.

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Published In

J Am Acad Orthop Surg

DOI

ISSN

1067-151X

Publication Date

March 2009

Volume

17

Issue

3

Start / End Page

183 / 196

Location

United States

Related Subject Headings

  • Warfarin
  • Risk Assessment
  • Review Literature as Topic
  • Pulmonary Embolism
  • Prothrombin Time
  • Preoperative Care
  • Practice Guidelines as Topic
  • Postoperative Care
  • Polysaccharides
  • Platelet Aggregation Inhibitors
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Johanson, N. A., Lachiewicz, P. F., Lieberman, J. R., Lotke, P. A., Parvizi, J., Pellegrini, V., … Watters, W. C. (2009). Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg, 17(3), 183–196. https://doi.org/10.5435/00124635-200903000-00007
Johanson, Norman A., Paul F. Lachiewicz, Jay R. Lieberman, Paul A. Lotke, Javad Parvizi, Vincent Pellegrini, Theodore A. Stringer, Paul Tornetta, Robert H. Haralson, and William C. Watters. “Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.J Am Acad Orthop Surg 17, no. 3 (March 2009): 183–96. https://doi.org/10.5435/00124635-200903000-00007.
Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pellegrini V, et al. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg. 2009 Mar;17(3):183–96.
Johanson, Norman A., et al. “Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.J Am Acad Orthop Surg, vol. 17, no. 3, Mar. 2009, pp. 183–96. Pubmed, doi:10.5435/00124635-200903000-00007.
Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pellegrini V, Stringer TA, Tornetta P, Haralson RH, Watters WC. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg. 2009 Mar;17(3):183–196.

Published In

J Am Acad Orthop Surg

DOI

ISSN

1067-151X

Publication Date

March 2009

Volume

17

Issue

3

Start / End Page

183 / 196

Location

United States

Related Subject Headings

  • Warfarin
  • Risk Assessment
  • Review Literature as Topic
  • Pulmonary Embolism
  • Prothrombin Time
  • Preoperative Care
  • Practice Guidelines as Topic
  • Postoperative Care
  • Polysaccharides
  • Platelet Aggregation Inhibitors