Fatal Pulmonary Embolism following Hip and Knee Replacement. A Study of 2153 Cases Using Routine Mechanical Prophylaxis and Selective Chemoprophylaxis

Abstract

In order to prevent fatal pulmonary embolism, TED stockings, foot pumps and early mobilisation on the second post-operative day are used at our centre. Only patients deemed to be high risk (previous DVT/PE or obese) are given clexane as inpatients and warfarin for six weeks post-op. From the hospital database 1137 primary total hip replacements and 1017 primary total knee re-placements were identified and the figures were confirmed with the theatre implant order books. The cause of death for those patients on the database, now deceased, was obtained from the coroner. Where a postmortem had not been performed the patient was assumed to have died of a PE. Within three months of surgery, a fatal PE rate of 0.09% (95% CI 0.00-0.26%) following hip replacement and 0.20% (95% CI 0.00-0.46%) after knee replacement was found. Thirty-four patients had been discharged on warfarin according to the pharmacy records. We would therefore not recommend the routine use of chemical thromboprophylaxis following joint replacement.

The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA

“…One of these studies followed 2153 cases undergoing total hip replacement and total knee replacements; of the eight autopsy-proven deaths, five (62.5%) were the result of ischemic heart disease. 88 The other study followed 1727 patients undergoing total hip replacements; there were seven (0.41%) deaths resulting from ischemic heart disease, four (0.23%) resulting from cerebrovascular events, and two (0.12%) resulting from PE. Four (0.23%) other patients died of nonvascular causes.…”

“…55 Aspirin also reduces the risk of Two recent studies showed ischemic heart disease was the most frequent cause of death, which supports the use of aspirin prophylaxis in view of its beneficial arterial effects. 10,88 Both studies used mechanical thromboprophylaxis and the patients were followed for 3 months. One of these studies followed 2153 cases undergoing total hip replacement and total knee replacements; of the eight autopsy-proven deaths, five (62.5%) were the result of ischemic heart disease.…”

Incidence of symptomatic Venous Thrombo Embolism (VTE), with or without chemoprophylaxis, in patients undergoing Total Knee Replacement: A comparative study

“…Implants used were Zimmer, Stryker, Smith & Nephew, Inor and Indus . Suction drains were used in all cases and kept for 24 hours .A strict protocol for mobilization of the patients following surgery was observed as a part of mechanical thromboprophylaxis (11,12) . Chemoprophylaxis agent when given was started on the day of surgery.…”

Status of Healthcare

“…VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE), which are the most serious complications of DVT. The PE mortality rate within the first few weeks following THA is between 0.09 % and 0.19 % (Fender et al 1997;Howie et al 2005;Khan et al 2007;Shepherd and Mills 2006).…”