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Do Pulmonary Emboli Arise from Lower Extremity Deep Venous Thrombosis?

Josephine

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Do Pulmonary Emboli Arise from Lower Extremity Deep Venous Thrombosis? POSTER NO. P079
Raviinder Parmar, MD, Naples, FL
Ronald Huang, Philadelphia, PA
Ibrahim Raphael, MD, Philadelphia, PA
Javad Parvizi, MD, Philadelphia, PA
Richard H. Rothman, MD, Philadelphia, PA


INTRODUCTION: Venous thromboembolism (VTE) is an important complication that may occur following total joint arthroplasty (TJA). It is a commonly held belief that pulmonary emboli (PE) arise from propagation of a deep venous thrombosis (DVT) and that prevention of DVT will lead to a reduction in PE. Our study was designed to examine the association between symptomatic DVT and PE in a consecutive group of patients undergoing TJA.

METHODS: This prospective study was initiated in April of 2010. A total of 1,710 TJA were performed at our institution between April of 2010 and December of 2010. Patients who had signs/symptoms of VTE postoperatively, were evaluated for both DVT and PE. A total of 129 patients were evaluated for DVT and/or PE by lower extremity ultrasound (US), chest CT, or V/Q scan within 90 days of arthroplasty. Of the 129 patients who were evaluated for VTE, 78 had symptoms of DVT and 51 had symptoms of PE. A test of association was performed in order to determine if the odds of developing positive symptomatic PE was significantly increased following positive symptomatic DVT and vice versa.

RESULTS: Of the 79 patients with symptoms of DVT, 14 had evidence of DVT of the lower extremities. Of 52 patients with suspected PE, 16 had PE based on imaging. Of 37 scanned for both DVT and PE, only seven patients (19% of those scanned for DVT and PE, 5.4% of the total cohort) had both DVT and PE.

DISCUSSION AND CONCLUSION: It appears that the commonly held notion that PE arise from symptomatic or asymptomatic DVT requires re-examination. PE and DVT may be part of a hypercoagulable state that can arise independently of each other. Thus, guidelines that use DVT as a proxy for PE may result in over anticogulation of patients with all its associated risks. This study was designed to examine the association between symptomatic DVT and PE in a consecutive group of patients undergoing TJA. No significant association between developing PE and DVT was found within 90 days of undergoing TJA.
 

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