Abstract
Thromboembolism is a potentially fatal complication of total joint replacement. Some surgeons follow a ‘prophylaxis without compromise’ policy, while others, who realise that there are risks attached to the use of prophylactic drugs, go to the opposite extreme and administer no prophylaxis and no anti-thrombotic drugs, even for pulmonary embolism.
We believe the results of surveillance should determine the administration of anticoagulation therapy. In over 1 500 patients, anticoagulants have been administered only when clinically indicated and after positive Duplex diagnosis. Death due to pulmonary embolism has occurred in only two patients in six years, a reduction from 1.0% to less than 0.05%.
Our treatment protocol divides our patients into high and low risk cases. The results of Doppler and blood tests dictate the method and extent of prophylaxis for high-risk cases, and the therapeutic handling of positive clot formation in the low-risk population.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
