How physicians and patients can work together to help mitigate complications
Illinois— A new review article
published in the April 15 issue of the Journal of the
American Academy of Orthopaedic Surgeons examines risk factors, prevention
and current treatment recommendations for venous thromboembolism (VTE)
after shoulder surgery.
What is venous
VTE is a potentially life-threatening disease that includes deep vein thrombosis (DVT), a condition in which a blood clot forms most often in the deep veins of the body and pulmonary embolism (PE), a complication in which the blood clot travels through the bloodstream and blocks flow to the lungs.
“As the rate of shoulder surgery continues to rise, so too
will the prevalence of patients who can develop venous thromboembolism,” said
lead study author and orthopaedic surgeonCatherine
Rapp, MD. “Fortunately, recent studies offer more guidance on the management of
VTE after shoulder surgery. While VTE after total hip and knee arthroplasty
has been well-studied, historically, the literature regarding VTE after
shoulder surgery has been lacking. This review aims to summarize the available
evidence and recommendations regarding VTE after shoulder surgery.”
Dr. Rapp and
her co-authors reviewed general literature that reported a wide range of VTE
rates after shoulder surgery, including:
Symptomatic VTE rates are higher after shoulder replacement (range, 0.24% to 2.6%) than after arthroscopy (range, 0.01% to 0.38%).
DVT rates are higher after shoulder replacement (range, 0.09% to 1.69%)
than after arthroscopy
(range, 0.01% to 0.38%) as are PE rates (range 0% to 3% versus 0% to 0.21%).
DVT rates after shoulder replacement were significantly higher than after arthroscopy at 13% versus 5.7%.
While most VTE events occur within the first postoperative week, they can occur up to three months after surgery.
suggest that while VTE can be challenging to diagnose, there are indications
for this condition: limb swelling, redness, pain, or a warm, solid, elevated
area of tissue or fluid inside or under the skin. If a physician sees a need
for concern, an ultrasonography is appropriate. A CT scan and MRI are the most
common alternative diagnostic options. Additionally, although the clinical
significance of an asymptomatic DVT is unknown, knowledge of the rates and risk
factors may assist in developing prevention strategies.
Standardized guidelines for VTE prevention after shoulder
The standardized guidelines for VTE prevention after shoulder surgery are lacking, according to the literature review authors, despite potentially significant long-term risks. Low-risk measures, such as early mobilization and sequential perioperative compression devices (a method used to improve blood flow), should be utilized in all patients when feasible. And higher risk strategies, such as pharmacologic prophylaxis (blood thinners) should be tailored on an individual basis.
Be aware for risk for VTE after shoulder surgery
“Patients should be aware of their risk for VTE after shoulder surgery and have an open conversation with their doctor about how to reduce their risk,” explained Dr. Rapp. “These factors may include but are not limited to patients with expected significant reduction in mobility, active cancer or cancer treatment, age 60 years or older, obesity, significant medical comorbidities such as diabetes and heart disease, and personal or family history of VTE. Patients should also pay attention to symptoms after surgery and weigh risks and benefits of treatment options with their physician.”
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