Embolic complications of calf thrombosis following total hip arthroplasty

Pellegrini, Vincent D.; Langhans, M; Tötterman, S.; Marder, Victor J.; Francis, Charles W.

doi:10.1016/s0883-5403(06)80210-x

Cited by 59 publications

(19 citation statements)

References 60 publications

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“…As IPC might be contraindicated with preoperative DVT, it is important to know the incidence of preoperative asymptomatic DVT when considering IPC for DVT and PE prophylaxis. Furthermore, what kind of treatment that is appropriate for asymptomatic distal DVT that has never been diagnosed without imaging modalities remains controversial [3,14,21,22,24]. We therefore identified the preoperative incidence of DVT diagnosed with routine ultrasonography before elective hip surgeries in an Asian population and clarified the natural course of asymptomatic DVT after the mechanical prophylaxis regimen without anticoagulant therapy for at least 6 months.…”

Section: Discussionmentioning

confidence: 99%

“…However, few attempts have been made at such observations. Numerous authors agree patients with proximal DVT are at risk for PE [9,14,22,24]. Giachino [9] reported 87% of fatal PEs originated from proximal DVTs.…”

Section: Discussionmentioning

confidence: 99%

“…However, the clinical importance of distal DVT remains controversial. Some authors consider asymptomatic distal DVTs to be associated with little or no increased risk [3,16,21,22], whereas others report patients with distal DVT have an increased risk for PE [9,14,24]. Kakkar et al [14] reported, in the 40 patients who had distal DVTs, DVTs of nine patients (23%) extended into the popliteal and femoral veins, and four patients (10%) had PEs.…”

Section: Discussionmentioning

confidence: 99%

“…The patients mean age at the time of surgery was 59 years (range, 23-84 years), and their mean body mass index (BMI) was 23 (range, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Preoperative diagnoses were osteoarthritis in 158 patients, osteonecrosis of the femoral head in 13, loosening of implants in 12, and rheumatoid arthritis in one.…”

Section: Methodsmentioning

confidence: 99%

“…However, without preoperative ultrasonographic screening of DVT, we might have used IPC even for patients with asymptomatic DVT. Moreover, postoperative routine ultrasonographic screening may increase the reported incidence of DVT, although the clinical importance of asymptomatic DVT remains controversial [3,14,21,22,24], and the natural course of postoperative asymptomatic DVT is unclear.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Tsuda

Kawasaki

Nakamura

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Tsuda

Kawasaki

Nakamura

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Management of Venous Thromboembolism

Hyers

2003

Arch Intern Med

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Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, represents a significant source of morbidity and mortality in the United States and worldwide. The pharmacologic management of venous thromboembolic disease has witnessed significant advances since oral anticoagulant and heparin therapies began to gain widespread use more than 50 years ago. Cumulative clinical experience gained from using these 2 classes of antithrombotic agents for the prevention and treatment of venous thromboembolism in high-risk patients pointed to a number of efficacy and safety limitations. This prompted further research and the eventual introduction, in the 1980s, of low-molecular-weight heparin(s) as a potentially superior therapeutic modality. Within the last decade the pace of development of newer classes of antithrombotic agents for venous thromboembolism prevention and treatment (as well as other indications) has accelerated. Among agents at late stages of investigation are ximelagatran (a direct thrombin inhibitor), nematode anticoagulant peptide c2 (a tissue factor VIIa inhibitor), and sodium N-[8(2-hydroxylbenzoyl)amino]caprylate (SNAC)/heparin (a heparin derivative). The most recently approved agents for venous thromboembolism indications include the heparinoid, danaparoid sodium, and the newly introduced selective factor Xa inhibitor, fondaparinux.

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A Critical Pathway to Evaluate Suspected Deep Vein Thrombosis

Pearson

Polak²,

Cartwright³

et al. 1995

Arch Intern Med

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Uncertainty regarding the optimal evaluation of suspected deep vein thrombosis (DVT) results in wide variations in practice, even within the same institution. To address variation in practice while maximizing the efficiency and quality of care, our institution developed a critical pathway guideline for the emergency department evaluation of patients suspected of having DVT. We present the critical pathway and the clinical rationale underlying its recommendations. The critical pathway was developed by a multidisciplinary team using chart review of practice at our institution, benchmarking at other institutions, and review and discussion of the medical literature. Consensus was achieved for the selection of ultrasound as the primary imaging test for all patients and for recommending initial doses of heparin sodium that are higher than the current norm at our institution to reduce the length of time required to achieve therapeutic anticoagulation. A total time for patient evaluation of 5 hours or less was established as the target. Controversy arose in two key areas: (1) the treatment of patients with normal ultrasound scans when high clinical suspicion for DVT exists and (2) the evaluation and treatment of suspected isolated calf-vein DVT. In its final form, the critical pathway recommendations seek to balance the benefits of standardization with the prerogatives of physicians to make decisions tailored to individual patients.

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Embolic complications of calf thrombosis following total hip arthroplasty

Cited by 59 publications

References 60 publications

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Management of Venous Thromboembolism

A Critical Pathway to Evaluate Suspected Deep Vein Thrombosis

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