Death after joint replacement.
This review considers the incidence of fatal pulmonary embolism following lower limb arthroplasty and femur neck fracture and considers whether some of these deaths are preventable. The data considered refer to short-term in-hospital prophylaxis with low-molecular-weight heparin and unfractionated heparin. Mortality rates depend on the type of surgery, with fracture of the femur being associated with the highest rates and knee replacement associated with the lowest. Short-term prophylaxis with dalteparin does appear to reduce the risk of death, but the risk extends well beyond discharge from hospital. Studies of extended out-of-hospital prophylaxis in order to reduce deaths related to thromboembolism are warranted.
Department of Musculoskeletal Science, University of Liverpool, UK. S.P.Frostwick@Liverpool.ac.uk
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D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002423:Cause of Death; D017985:Dalteparin / Q000627:therapeutic use; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017985:Dalteparin