Saturday, December 17, 2011

Pulmonary embolism, thromboembolic prophylaxis and shoulder arthroplasty

National organizations have developed guidelines for the prevention of blood clots after hip and knee surgery The guidelines from the American Academy of Orthopaedic Surgeons can be found here.

The risk of pulmonary embolism after shoulder arthroplasty is much less than after hip and knee surgery, probably because the patient can be up and walking around immediately after the procedure.

Our practice is to screen patients for conditions that predispose them to a high risk of blood clots and for other reasons for them to take anticoagulants, such as coumadin, including past history of pulmonary emboli. In the absence of specific indications for medical thrombophrophylaxis, we use early ambulation and compressive stockings and sequential pressure devices to reduce the risk of blood clots. We avoid anticoagulants if possible to reduce the risk of bleeding at the site of our shoulder surgery.

It is a question of balancing one risk versus another for each patient.


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