Treatment of Pulmonary Embolism in Total Hip Replacement

The clinical significance of pulmonary embolism: uncertainties and implications for treatment – a debate

“…Nielsen et al [32] 1994 1 (n l 57) 0 (n l 57) Johnson & Charnley [33] 1977 1 (n l 295) 0 (n l 308) Barritt & Jordan [34] 1960 0 (n l 54) 5 (n l 19)…”

Thromboembolic Disease After Combined Anterior/Posterior Reconstruction for Adult Spinal Deformity

“…Thromboembolic disease (TED) is a well-known complication after orthopedic operations, with rates of deep venous thrombosis (DVT) and pulmonary embolism (PE) in nonprophylaxed arthroplasty patients reaching 20% to 84% [1][2][3][4][5] and 1% to 7.9%, [5][6][7][8] respectively. This has led to widespread, aggressive postoperative DVT prophylaxis-usually with both mechanical and chemical means.…”

Do anticoagulants improve survival in patients presenting with venous thromboembolism?

“…Furthermore, Barritt and Jordan's trial [5], despite its shortcomings, is fairly persuasive direct evidence that anticoagulants improve the outcome in more severe forms of PE. Although the studies of Johnson [84], Nielsen [6, 7] and Kim [75] are apparently at odds with this body of evidence, when viewed in the Bayesian context of the total edifice of evidence, they probably should not greatly shift our degree of belief in the precept that anticoagulants are effective in the prevention of recurrent fatal PE. And whilst the majority of PE‐related deaths occur in patients with comorbidities and/or inadequate cardiorespiratory reserve, the fact that a significant minority occur in previously fit patients [50, 90], and that recurrent fatal PE occurred in up to one‐fifth of untreated patients without cardiac disease who had clearly survived the initial event in early series [43], suggest that VTE should not be regarded as benign in unselected, previously fit patients.…”

“…Johnson et al. [84] reviewed outcomes in 603 post‐hip arthroplasty patients from 1962 to 1973 in a prospective registry with clinically diagnosed PE which was not fatal at presentation. A total of 295 patients were treated with anticoagulants, whilst 308 cases were treated conservatively.…”