The incidence of fatal pulmonary embolism after primary hip and knee replacement in a consecutive series of 4253 patients.
We studied 4253 patients undergoing primary joint replacement between November 2002 and November 2007, of whom 4060 received aspirin only as chemical prophylaxis; 46 were mistakenly given low molecular weight heparin initially, which was stopped and changed to aspirin; 136 received no chemoprophylaxis and 11 patients received warfarin because of a previous history of pulmonary embolism. We identified the rate of clinical thromboembolism before and after discharge, and the mortality from pulmonary embolism at 90 days. The overall death rate was 0.31% (13 of 4253) and the rate of fatal pulmonary embolism was 0.07% (3 of 4253). Our data suggest that fatal pulmonary embolism is not common following elective primary joint replacement, and with modern surgical practice elective hip and knee replacement should no longer be considered high-risk procedures.
Cusick
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Orthopaedic Outcomes Department, Musgrave Park Hospital, Belfast, Northern Ireland. laurencecusick@hotmail.com
Beverland
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000401:mortality*; D001241:Aspirin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000401:mortality*; D013923:Thromboembolism / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D001241:Aspirin