Friday, August 30, 2013

Shoulder joint replacement and blood clots - pulmonary emboli and venous thrombosis

Venous thromboembolism after shoulder arthroplasty: a systematic review

The authors of this article conducted a literature review of 14 articles reporting at least 1 case of deep vein thrombosis or pulmonary embolism after shoulder arthroplasty. The reported incidence these complications ranged from 0.2% to 16.0%. Risk factors for these complications included a history of VTE, thrombophilia, major surgery, advanced age, current malignant disease, immobility, and bed confinement. They were unable to find clear guidance for prophylaxis. 

Comment - It is important to differentiate venous clots from pulmonary emboli. Many studies lump these two together as "venous thromboembolism".  Preventing pulmonary emboli is the target. The most important risk factor is a history of a previous pulmonary embolism. Also high on the list are know hypercoagulable states such as Factor V Leiden and antiphospholipid syndrome or antiphospholipid antibody syndrome.

All our patients have sequential compression devices (SCDs) applied in the operating room before surgery and continued until they are ambulatory. Patients are out of bed within 24 hours of their surgery and are encouraged to actively move their legs while in bed.

In our shoulder arthroplasty practice, we do not use routine medical prophylaxis, such as unfractionated or fractionated heparin or low molecular weight heparin (e.g. Lovenox, Fondaparinux) except in high risk cases because of the increased risk of bleeding into the wound.

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