TREATMENT OF EARLY SYMPTOMATIC PULMONARY-EMBOLISM AFTER TOTAL JOINT ARTHROPLASTY

The purpose of this study was to evaluate the risk of intravenous hepa rin therapy or the use of Greenfield filters (Meditech, Watertown, MA) in the early postoperative period in patients who have documented sym ptomatic pulmonary embolism. Symptomatic pulmonary embolism in the fir st weeks was identified in 52 patients. Twenty-four patients were trea ted with Greenfield filter insertion and 28 patients with intravenous heparin therapy. One complication associated with insertion of the Gre enfield filter-premature opening in the internal jugular vein-resulted in no adverse consequences. Three complications were associated with intravenous heparin therapy: one transient thrombocytopenia, one recur rent symptomatic pulmonary embolism, and one knee hematoma, which did not require surgical evacuation. It appears that Greenfield filter ins ertion is a viable option for treatment of symptomatic pulmonary embol ism in the early postoperative period after total joint arthroplasty. In contrast to other published data, this study suggests that intraven ous heparin therapy may also be a reasonable alternative, but is a tre atment regimen that requires careful monitoring of platelets, wound co mplications, and bleeding parameters.