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Diagnosis and Treatment of Deep Vein Thrombosis and Pulmonary Embolism After Major Joint Surgery

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Thromboembolism in Orthopedic Surgery

Abstract

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are two clinical presentations of venous thromboembolism (VTE) and share the same predisposing factors. In a study by our group, the Spanish National Discharge Database was used to assess the frequency and clinical impact of venous VTE after elective total knee (TKA) or hip (THA) arthroplasty. In all, 58,037 patients underwent TKA, and 31,769 underwent THA. Of these, 179 (0.20 %) were diagnosed with symptomatic PE, 470 (0.52 %) were diagnosed with DVT, and 106 (0.12 %) died during the first 3 months after surgery. Mean hospital stay was significantly longer in patients who developed VTE than in those who did not. Of 106 patients who died, 20 (19 %) had been diagnosed with PE.

The first step in diagnosis VTE is the suspicion. Acute VTE should be suspected in patients with a combination of suggestive symptoms and/or signs. Most patients with confirmed PE do not have clinically evident DVT, and around 30 % of patients with symptomatic DVT have asymptomatic PE. The objectives of VTE treatment are to improve acute symptoms and to prevent thrombus extension, early recurrence, and death from PE. In most patients, the initial treatment of DVT and PE is similar since both conditions are considered different manifestations of the same disease. Anticoagulation remains the mainstay of VTE treatment.

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Authors and Affiliations

  1. Department of Internal Medicine, Hospital Germans Trias I Pujol, Badalona, Barcelona, 08916, Spain

    Manuel Monreal M.D., Ph.D.

  2. Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Calle Madrid s/n, Granada, 18071, Spain

    Juan I. Arcelus M.D., Ph.D.

Authors
  1. Manuel Monreal M.D., Ph.D.
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  2. Juan I. Arcelus M.D., Ph.D.
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Correspondence to Manuel Monreal M.D., Ph.D. .

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Editors and Affiliations

  1. , Department of Anaesthesiology and Critic, University Hospital of Valencia, Valencia, 46010, Spain

    Juan V. Llau

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Monreal, M., Arcelus, J.I. (2013). Diagnosis and Treatment of Deep Vein Thrombosis and Pulmonary Embolism After Major Joint Surgery. In: Llau, J. (eds) Thromboembolism in Orthopedic Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4336-9_4

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  • DOI: https://doi.org/10.1007/978-1-4471-4336-9_4

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