title: Pulmonary embolism after total joint arthroplasty: cost and effectiveness of four treatment modalities.
abstract: Pulmonary embolism (PE) treatment relies on therapeutic anticoagulation and may be associated with severe complications. Inferior vena cava filters (IVCFs) are used as an alternative/adjunct to anticoagulation. In this study we evaluate 4 treatment protocols for clinical efficacy and cost. We reviewed over 27,000 total joint arthroplasty (TJA) patients. We retrospectively identified 294 patients with a documented, symptomatic PE within 90 days of surgery. All patients were treated with warfarin postoperatively. In addition, for the acute management, patients were divided into four treatment groups: (1) IVCF only, (2) IVCF with heparin, (3) heparin only and (4) no treatment. Complication rates, hospital stay and PE recurrence are reported. Among patients who received warfarin, IVCF was associated with fewer complications and lower overall hospital costs compared to the use of heparin for the treatment of PE after TJA.
authors.affiliation: Orthopaedic Research at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Ibrahim J
authors.initials: IJ
authors.lastname: Raphael
authors.affiliation: Orthopaedic Research at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: James C
authors.initials: JC
authors.lastname: McKenzie
authors.affiliation: Orthopaedic Research at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zmistowski
authors.affiliation: Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Brown
authors.affiliation: Orthopaedic Surgery at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.affiliation: Orthopaedic Surgery at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin
keywords: anticoagulation; hip; inferior vena cava filter; knee; pulmonary embolus; total joint arthroplasty