Question

Bone & Joint Injuries

How are blood clots prevented after knee or hip replacement surgery?

A Answers (2)

  • AScott Martin, Orthopedic Surgery, answered
    One potential postsurgical danger after joint replacement surgery is the development of a blood clot that travels to the lung, lodging there and blocking off your breathing (pulmonary embolism). To help prevent blood clots, your doctor may place compression devices around your legs and feet. These devices are hooked to a machine that regularly fills them with air to squeeze your calves, forcing blood up your legs to mimic the action that your muscles would provide if you were moving around. Elastic stockings (TED or anti-embolic stockings) worn on both legs keep pressure on your calf muscles (and thereby your legs) to enhance blood flow. Your doctor is likely to prescribe injections of a blood-thinning medication such as heparin soon after surgery, and then switch you to an oral anticoagulant such as warfarin (Coumadin) to be taken at home for up to several weeks after surgery. Results of a large study published in The New England Journal of Medicine found that a drug known as rivaroxaban (Xarelto) may be particularly effective at preventing blood clots after total knee replacement and total hip replacement surgery, possibly because the drug targets and inhibits clotting factors that are active after major orthopedic surgery.

    You can help prevent clots by moving around as much as you are allowed. While in bed, increase blood flow by circling your ankles or alternately flexing and pointing your feet. Report any symptoms of a possible leg clot: increasing swelling, pain, tenderness, or redness in your calf. A clot that has reached the lung can cause shortness of breath or chest pain that comes on suddenly with coughing; if this happens, notify your doctor immediately.
  • AVonda Wright, MD, Orthopedic Surgery, answered

    Bloods clots, also known as deep vein thrombosis (DVT), can be prevented after lower extremity total joint arthroplasty through a variety of methods.

    Mechanical methods of DVT prevention may be recommended by the treating physician. Sequential compressive devices (SCDs) are one such mechanical method. These devices consist of sleeves that fit around the calves or lower legs and are attached to a small machine that delivers minor squeezes to the calves to help prevent blood from pooling in the veins. These are generally worn while one is lying in the hospital bed. Compressive stockings that fit around the feet and calves are also an option for mechanical DVT prophylaxis. These too help prevent blood from pooling in the veins. If agreeable with the post-operative plan, getting out of bed and moving around as much as possible is also instrumental in preventing DVTs.

    Pharmacological methods of DVT prevention are a common option following total joint surgery. Some of these blood thinning drugs are aspirin, low molecular weight heparins such as enoxaparin (Lovenox), warfarin (Coumadin), or a newer drug rivaroxaban (Xarelto). Each drug is associated with its own risks and benefits. While warfarin is the strongest blood thinner of the group previously mentioned, it carries the highest risk of significant bleeding events. The low molecular weight heparins like Lovenox are generally held to be safer than warfarin but still carry a bleeding risk. Low molecular weight heparins are also associated with patient discomfort because they must be injected under the skin on a daily basis. Xarelto is a more recently approved drug for DVT prophylaxis. It is similar to the low molecular weight heparins, however it is taken orally. It is also the most expensive of the previously mentioned drugs.

    As with any preventative medical treatment, the above methods do not guarantee prevention of DVTs although they do help reduce the risk.

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