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

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 pulmonary emboli," said Paul Tornetta, MD, lead author of the study.

"Some recent studies have shown that while the incidence of diagnosis of pulmonary embolism 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

Aggressive treatment of PE typically includes the use of anticoagulants 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 blood clots 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 clot formation and bleeding events, they can pose a unique dilemma 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 blood thinners 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.


Contact: Kayee Ip
American Academy of Orthopaedic Surgeons

Related medicine news :

1. Anti-clotting drugs yield similar results
2. Immunodeficient patients with secondary lung disease benefit from combined chemotherapy
3. Possible therapy for tamoxifen resistant breast cancer identified
4. Breast Cancer Drug Might Help Men on Prostate Cancer Therapy
5. Early use of stents better than medical therapy alone for certain patients
6. RI Hospital researcher: Older women may not benefit from radiotherapy after breast surgery
7. Moffitt Cancer Center researchers validate molecular signature to predict radiation therapy benefit
8. Therapy combining exercise and neuroprotective agent shows promise for stroke victims
9. Couples Therapy May Help Combat PTSD
10. CNIO researchers discover a new therapy that prevents lung cancer growth in mice
11. 7-Day Stuttering Therapy May Get Results, Study Says
Post Your Comments:
(Date:11/27/2015)... ... 2015 , ... Dr. Thomas Dunlap and Dr. Patrick Coleman ... with Emergency Medicine at St., Joseph Health System’s Santa Rosa Memorial Hospital , ... in similar ways and require time-critical intervention to avoid large area heart damage and ...
(Date:11/27/2015)... ... 27, 2015 , ... Indosoft Inc., developer and distributor of ... 11 LTS (Long Term Support) into its Q-Suite 5.10 product line. , Making ... with a version of Asterisk that will receive not only security fixes, but ...
(Date:11/26/2015)... ... November 26, 2015 , ... Inevitably when people think Thanksgiving, they ... to buy during the Black Friday and Cyber Monday massage chair sales ... the Internet high and low to find the best massage chair deals, they can ...
(Date:11/26/2015)... ... November 26, 2015 , ... Somu Sivaramakrishnan announced today that ... Somu now offers travelers, value and care based Travel Services, including exclusive pricing ... well as, cabin upgrades and special amenities such as, shore excursions, discounted fares, ...
(Date:11/26/2015)... Omaha, NE (PRWEB) , ... November 26, 2015 , ... ... careers searched by healthcare professionals and offered by healthcare staffing agency Aureus Medical ... top during the month of October 2015 among those searching for healthcare jobs through ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... 26, 2015  The total global healthcare industry is expected ... Latin America has the highest projected ... Japan ), is second with growth projected ... face increased healthcare expenditure. In 2013-2014, total government funded healthcare ... in 2008-2009 to 41.2% in 2013-2014. In real terms, out ...
(Date:11/25/2015)... , Nov. 25, 2015 AAIPharma ... planned investment of at least $15.8  Million to ... Wilmington, NC . The expansion will ... to meet the growing demands of the pharmaceutical ... site expansion will provide up to 40,000 ...
(Date:11/25/2015)... AVIV, Israel , November 25, 2015 ... (NASDAQ: KTOV ) (TASE: KTOV), a biopharmaceutical company ... simultaneous treatment of various clinical conditions, today announced the ... 3,158,900 American Depository Shares ( ADSs ), each representing ... purchase up to 3,158,900 ADSs. The ADSs and warrants ...
Breaking Medicine Technology: