Don't Overreact to Pulmonary Emboli Risks

Patients who undergo joint replacement surgery are at increased risk of developing pulmonary emboli, but aggressive treatment with anticoagulants is not always needed, according to new research published in the Journal of the American Academy of Orthopaedic Surgery.

Mortality rates linked to pulmonary emboli are not increasing at the same rate as the complication's diagnosis, which suggests some clots are more dangerous than others, says Paul Tornetta, MD, the study's lead author and vice chairman of orthopaedic surgery at Boston University School of Medicine in Massachusetts.

All clots may therefore not require the same level of blood thinners for treatment, he says, adding that sensitive tests, such as computerized tomography pulmonary angiograms, used to detect potentially lethal and symptom-free clots may also be picking up small, relatively insignificant blockages.

Administering anticoagulants indiscriminately increases the likelihood of post-op bleeding, another risk joint replacement patients face, notes the AAOS. Dr. Tornetta says physicians must instead use broader criteria when screening for clinically relevant pulmonary emboli and gauge the timing, risks and outcomes of blood-thinning treatment.

"Based on current studies, there is no consensus as to what type of treatment, if any, is required when small clots are detected," says Dr. Tornetta. "New guidelines may be needed to help doctors more accurately identify which patients could benefit from anticoagulant therapy and help to balance the risks of aggressive anticoagulation."

Daniel Cook