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Not all pulmonary emboli have same clinical relevance after joint replacement, trauma surgery

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Surgeons should identify the pulmonary emboli that present a risk of mortality before the treatment of patients following total joint replacement or trauma surgery, according to researchers from Boston University.

“Some recent studies have shown that while the incidence of diagnosis of pulmonary embolism (PE) is increasing, there is not a corresponding increase in mortality,” Paul Tornetta, MD, lead author from the Boston University Medical Center in Boston, stated in a press release. “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.”

Researchers said that instead of treating PE with aggressive measures like anticoagulants after the identification of the event on an imaging scan, such as a CT pulmonary angiogram, surgeons should note the size of a clot and whether it poses a risk for mortality before moving forward. The identification of which PE in joint replacement or trauma patients are life-threatening can help reduce patient risk and improve outcomes, they noted.

 “Based on current studies, there is no current consensus as to what type of treatment, if any, is required when small clots are detected,” Tornetta stated. “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 coagulation.”

Reference:

Tornetta P, Bogdan Y. Pulmonary embolism in orthopaedic patients: diagnosis and management. J Am Acad Orthop Surg. 2012; Sep:20(9):586-595. doi:10.5435/JAAOS-20-09-586.

Disclosure: Tornetta is a consultant for and receives royalties from Smith & Nephew.