Aspirin prophylaxis for pulmonary embolism following total hip arthroplasty. An incidence study.
Although this study was performed on a relatively small number of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis for postoperative pulmonary embolism, several important points are noted: the use of pre- and postoperative lung perfusion scanning can eliminate a 15% rate of false-positive diagnosis of pulmonary embolism, and pulmonary embolism occurred in approximately 8% of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis, without fatality. This occurred despite the inclusion of high-risk patients. "Silent" pulmonary embolization occurred in 4.1% of these patients. Patients who have a history of a thromboembolism, a delayed postoperative course, and two or more risk factors for pulmonary embolism present, are at risk of developing a postoperative pulmonary embolism, despite aspirin therapy, and should be managed more aggressively, i.e., early detection or prophylactic anticoagulation therapy.