Sunday, December 14, 2014

Preventing thromboembolic disease after shoulder arthroplasty

Risk of venous thromboembolism after shoulder arthroplasty in the Medicare population

These authors used Medicare claims data to determine the national incidence of symptomatic venous thromboembolism (VTE) after 130,258 shoulder arthroplasty during the index surgical admission and after discharge. Data were compared to 2,509,530 lower extremity arthroplasties.

VTE complications occurred in 0.53% of shoulder arthroplasties and 1.2% of lower extremity arthroplasties.  The risk of these complications were increased with fractures, a history of VTE, cardiac arrhythmia, presence of a metastatic tumor, coagulopathy, congestive heart failure, alcohol abuse, and obesity.

The authors recommend the use of mechanical prophylaxis combined with aspirin for shoulder arthroplasty patients who are not at increased risk of VTE. Chemoprophylaxis with agents other than aspirin may be warranted in patients with a demonstrated risk of VTE.

Comment: These results can be compared to those in previous post shown here. Our practice is consistent with the recommendations of these authors for routine cases. The situation becomes more complex in patients with prior history of VTE, who have artificial heart valves, atrial fibrillation, hyper coagulable states, and other risk factors. In these cases the care team must balance the risk of VTE agains that of bleeding and discuss the options with the patient. If patients are placed on anticoagulants, post operative motion may need to be restricted and the wound observed closely for bleeding.


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