title: Pulmonary embolism prophylaxis in more than 30,000 total knee arthroplasty patients: is there a best choice?
abstract: Prophylaxis for pulmonary embolism (PE) prevention in total knee arthroplasty remains controversial. A joint registry evaluated venous thromboembolism prophylaxis and anesthesia impact on the incidence of PE, fatal PE, and death. Patients received mechanical prophylaxis alone or chemical with or without mechanical prophylaxis. The overall PE incidence was 0.45%; fatal PE, 0.01%; and death, 0.31%. The only significant difference in any outcome was the incidence of PE between Coumadin and mechanical prophylaxis alone. Variables associated with a higher incidence of PE were age, an American Society of Anesthesiologists score of 3 or higher, and the use of general anesthesia. Based on the findings, general anesthesia can be discouraged, and only Coumadin fared better than mechanical prophylaxis alone, whereas other forms of chemical prophylaxis revealed no significant differences.
authors.affiliation: Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Baldwin Park, California, USA.
authors.forename: Monti
authors.initials: M
authors.lastname: Khatod
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
authors.forename: Stefano A
authors.initials: SA
authors.lastname: Bini
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Paxton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D002140:California; D015331:Cohort Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D001241:Aspirin