title: Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.
abstract: This clinical practice guideline is based on a systematic review of published studies on the management of adult patients undergoing total hip replacement (THR) or total knee replacement (TKR) aimed specifically at preventing symptomatic pulmonary embolism (PE). The guideline emphasizes the need to assess the patient's risk for both PE and postoperative bleeding. Mechanical prophylaxis and early mobilization are recommended for all patients. Chemoprophylactic agents were evaluated using a systematic literature review. Forty-two studies met eligibility criteria, of which 23 included patients who had TKR and 25 included patients who had THR. The following statements summarize the recommendations for chemoprophylaxis: Patients at standard risk of both PE and major bleeding should be considered for aspirin, low-molecular-weight heparin (LMWH), synthetic pentasaccharides, or warfarin with an international normalized ratio (INR) goal of < or =2.0. Patients at elevated (above standard) risk of PE and at standard risk of major bleeding should be considered for LMWH, synthetic pentasaccharides, or warfarin with an INR goal of < or =2.0. Patients at standard risk of PE and at elevated (above standard) risk of major bleeding should be considered for aspirin, warfarin with an INR goal of < or =2.0, or none. Patients at elevated (above standard) risk of both PE and major bleeding should be considered for aspirin, warfarin with an INR goal of < or =2.0, or none.
authors.affiliation: Department of Orthopaedic Surgery, Drexel University College of Medicinbne, Philadelphia, PA, USA.
authors.forename: Norman A
authors.initials: NA
authors.lastname: Johanson
authors.forename: Paul F
authors.initials: PF
authors.lastname: Lachiewicz
authors.forename: Jay R
authors.initials: JR
authors.lastname: Lieberman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lotke
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Vincent
authors.initials: V
authors.lastname: Pellegrini
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Stringer
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
authors.forename: Robert H
authors.initials: RH
authors.lastname: Haralson
authors.forename: William C
authors.initials: WC
authors.lastname: Watters
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D007430:Intraoperative Care / Q000379:methods; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011134:Polysaccharides / Q000627:therapeutic use; D011182:Postoperative Care / Q000379:methods; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D012196:Review Literature as Topic; D018570:Risk Assessment; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D011134:Polysaccharides; D014859:Warfarin; D001241:Aspirin