Incidence:40-60% of THR or 0.19% (Fender et al,JBJS 1997) showed that the incidence of fatal PE (as diagnosed bypostmortem examination) was 4 / 2111 patients (0.19%).
: 50%(incidence)-10%(embolize)-2% (Die). With prevention-reduce by one fifth(10%-2%-0.4%)
(O’Reilly RF et al. The prevalence of venous thromboembolism after hip and knee replacement surgery.
Med J Aust
2005; 182; 154-159.) 5999patients.DVT after THR 8.9% with prophylaxis.Fatal in-hospital PE rare, 0.05%).
Diagnosis:ultrasound prior to discharge and ? Repeat in high riskPrevention:aspirin-probably not enough.heparin and low molecular wt agents.reduces risk by 70%, start before incision-? pentasaccharides-warfarin adjusted-dose, INR 2.5 (2 to 3), 10 days post-opcompressive devices ? proofvena cava filterMIS THR ? lower
Treatment:standard treatment algorithm (confirmation of DVT/PE, followed by IVheparin or SQ low molecular wt heparin, followed by oral warfarin
(once started patient is OK).