In a previous blog, I discussed the issue of anticoagulation therapy (blood thinning) after total hip and knee replacement. The ultimate goal of all of our efforts to thin a patient’s blood after joint replacement surgery is to prevent pulmonary embolus or, in laymen’s terms, blood clots spreading to the lungs. There are several forms of anticoagulant therapy and these include the use of Coumadin, low-molecular weight heparins such as Lovenox or Arixtra, or use of aspirin. In addition, mechanical measures such as compression devices for the legs can be used while the patient is in the hospital.
A recent review by the American Academy of Orthopaedic Surgeons found that aspirin was as effective as Coumadin and low-molecular weight heparins at preventing pulmonary embolus, though prior studies have documented that it is not as effective in preventing blood clots in the legs.
The challenge for doctors and patients alike is balancing the thinning of blood and prevention of blood clots with increased bleeding at the site of surgery causing hematomas or collection of blood at the site of the surgery that can require subsequent procedures to drain the wound of the excess blood. This continues to be a hotly debated topic with orthopedic surgeons favoring a less aggressive approach because of the problems associated with excess bleeding such as wound breakdown and infection and internists who treat pulmonary embolus who favor more aggressive thinning measures. There is no clear-cut correct answer but further clarification of this issue is awaiting debate of the recent Orthopaedic Academy recommendations. At the present time, we use a combination of all three agents trying to tailor the anticoagulation regimen to the patient’s needs.
William P. Barrett, M.D.