Anti-clotting therapy may be used too often following orthopaedic surgery or trauma

September 1, 2012

Men and women who undergo joint replacement procedures, as well as those who have significant fractures, tend to be at an increased risk of developing pulmonary emboli (PE), blood clots that travel to the lungs where they may cause serious complications and even death. Patients are often aggressively treated with anticoagulants, or blood thinners, to help prevent the clots from forming, but a study published in the September 2012 issue of the Journal of the American Academy of Orthopaedic Surgeons indicates that some blood clots being identified by today's sensitive testing methods may not require aggressive treatments.

"If these clots break away from the wall of the blood vessel and travel to the lungs; this is called ," said Paul Tornetta, MD, lead author of the study.

"Some recent studies have shown that while the incidence of diagnosis of is increasing, there is not a corresponding increase in mortality," Dr. Tornetta added. "What this suggests is that not all clots have the same clinical relevance—that is, they may not require the same aggressive level of blood thinners for treatment—and that increasingly sensitive tests may be picking up small, relatively insignificant clots that would not necessarily require treatment."

Risks of Treatment

of PE typically includes the use of to prevent blood clot propagation. However, orthopaedic patients also are at an increased risk for postoperative bleeding and blood thinner usage can increase that risk.

Accurately identifying that need treatment, as well as those that are not likely to cause complications, could help physicians reduce patient risks and improve outcomes. Currently, though, there are no standard guidelines for differentiating between clots that require treatment and those that do not. "Because these patients are at increased risk for both and bleeding events, they can pose a unique which can be very challenging to treat," Dr. Tornetta noted.

In addition to the increased PE risks associated with some orthopaedic procedures or injuries, other factors also can increase a patient's chances of developing one of these conditions, including:

  • Older age
  • Use of oral contraceptives
  • Having a personal or family history of PE
  • Undergoing extensive or prolonged surgical procedures
  • Undergoing a lengthy period of immobilization following surgery or trauma

Identifying Clots and Diagnosing PE

Many patients with PE have specific symptoms, including:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing
  • Rapid heart beat
However, many orthopaedic patients with potentially dangerous clots do not have symptoms. For these patients, other methods of diagnosis must be used, including blood tests and imaging studies. The most common and popular imaging test is the computerized tomography pulmonary angiogram (CTPA), a very sensitive test that is capable of identifying potentially serious clots that could otherwise go undetected. But, because the CTPA is so sensitive, it may also identify much smaller clots which could resolve without use of anticoagulants.

"While it's clear that the use of is of paramount importance in treating clinically relevant PE to prevent death, it is also becoming clear that many of these patients may not need the same aggressive level of these medications, which could substantially reduce their risks of bleeding problems," Dr. Tornetta said.

Different Approach

While there is no consensus regarding optimal PE treatment, Dr. Tornetta said the results of the recent studies indicate that physicians who treat orthopaedic surgery and trauma patients may need to use broader criteria when screening for potentially dangerous clots before beginning anticoagulant therapy. Some studies have shown that both the size and the location of the blood clot may be useful in determining whether or not to use blood thinning drugs.

"Based on current studies, there is no consensus as to what type of treatment, if any, is required when small clots are detected," Dr. Tornetta said. "Today's more sensitive detection methods are alerting physicians to small clots that may not require anticoagulant treatment. New guidelines may need to be developed that can help doctors more accurately identify which patients could benefit from anticoagulant therapy and help to balance the risks of aggressive anticoagulation."

Future studies may provide information which can be used to develop guidelines for the treatment of orthopaedic patients with small clots. Until then, as with any drug therapy, patients should discuss the risks and benefits associated with the use of anticoagulants following significant orthopaedic injury or surgery, he added.

Explore further: Joint replacement surgery increases risk of blood clot formation in certain patients

Related Stories

Joint replacement surgery increases risk of blood clot formation in certain patients

July 27, 2011
When tennis star Serena Williams underwent emergency treatment for a pulmonary embolism earlier this year, the world's attention was drawn to this often fatal medical condition which, although surprisingly not uncommon, is ...

Preventive use of blood thinners by cancer patients could save lives, cut costs

December 13, 2011
(Medical Xpress) -- Preventive use of blood thinners, or anticoagulants, in  people receiving outpatient treatment for cancer could prevent the development of blood clots and improve their quality of life, according ...

'Clot-busters' no more effective than traditional therapy in treating lung blood clots

May 16, 2011
Although so-called clot-busting drugs are commonly used in the treatment of some patients with blood clots in the lungs, a new study conducted by researchers in Spain and the U.S. indicates the agents do not appear to be ...

New guideline outlines recommendations to reduce blood clots after hip and knee replacement

September 30, 2011
An updated clinical practice guideline released last week by the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors recommends how to reduce the likelihood of blood clots after hip or knee replacement surgery, ...

ACP recommends new approach to prevent venous thromboembolism in hospitalized patients

October 31, 2011
In a new clinical practice guideline published today in Annals of Internal Medicine, the American College of Physicians (ACP) recommends that doctors assess the risk of thromboembolism and bleeding in patients hospitalized ...

Recommended for you

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

dfwrunner
not rated yet Sep 01, 2012
used too often? I developed a clot behind me knee after PF and Tarsal tunnel decompression. It broke up and spread to my lungs nearly killing me. I went to the doc almost immediately with pain behind my knee and he told me it was nothing. Several days later i could barely breathe.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.