Pulmonary Embolism While on Aspirin for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty

Francisco Roman, Jay Sheree Allen, Heather Catherine Wurm, Kathy Mac Laughlin

Research output: Contribution to journalArticle

Abstract

A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.

Original languageEnglish (US)
JournalJournal of Primary Care and Community Health
Volume9
DOIs
StatePublished - Aug 1 2018

Fingerprint

Knee Replacement Arthroplasties
Venous Thromboembolism
Pulmonary Embolism
Aspirin
Organizations
Drug-Eluting Stents
Primary Care Physicians
Embolism
Chest Pain
Pulmonary Artery
Hospital Emergency Service
Coronary Artery Disease
Patient Care
Angiography
Arteries
Tomography
Guidelines
Lung
Therapeutics

Keywords

  • anticoagulation
  • aspirin
  • pulmonary embolism
  • total knee arthroplasty
  • venous thromboembolism prophylaxis

ASJC Scopus subject areas

  • Community and Home Care
  • Public Health, Environmental and Occupational Health

Cite this

Pulmonary Embolism While on Aspirin for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty. / Roman, Francisco; Allen, Jay Sheree; Wurm, Heather Catherine; Mac Laughlin, Kathy.

In: Journal of Primary Care and Community Health, Vol. 9, 01.08.2018.

Research output: Contribution to journalArticle

@article{3ca16064c4de4b6782feae804325a471,
title = "Pulmonary Embolism While on Aspirin for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty",
abstract = "A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.",
keywords = "anticoagulation, aspirin, pulmonary embolism, total knee arthroplasty, venous thromboembolism prophylaxis",
author = "Francisco Roman and Allen, {Jay Sheree} and Wurm, {Heather Catherine} and {Mac Laughlin}, Kathy",
year = "2018",
month = "8",
day = "1",
doi = "10.1177/2150132718797446",
language = "English (US)",
volume = "9",
journal = "Journal of primary care & community health",
issn = "2150-1319",
publisher = "Sage Periodicals Press",

}

TY - JOUR

T1 - Pulmonary Embolism While on Aspirin for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty

AU - Roman, Francisco

AU - Allen, Jay Sheree

AU - Wurm, Heather Catherine

AU - Mac Laughlin, Kathy

PY - 2018/8/1

Y1 - 2018/8/1

N2 - A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.

AB - A 62-year-old Caucasian man with past medical history significant for coronary artery disease, status post drug eluting stent to the left anterior descending artery 10 years prior, was admitted for elective total right knee arthroplasty. His intraoperative course was uneventful, and he was discharged on hospital day 2 on aspirin 325 mg twice daily for 6 weeks for venous thromboembolism (VTE) prophylaxis. Three weeks later the patient developed chest pain shortly after an approximately 1-hour flight and presented to a local emergency department where computed tomography angiogram showed pulmonary emboli involving segmental and subsegmental pulmonary arteries bilaterally. He was transitioned from aspirin 325 mg twice a day to rivaroxaban 15 mg twice daily for 21 days, with a plan to transition to 20 mg daily to complete a 3-month course. He returned to his primary care physician 6 days after discharge with questions about his current anticoagulation therapy as well as the regimen he was on prior to the pulmonary embolism. Two major organizations, The American Academy of Orthopedic Surgeons and The American College of Chest Physicians, provide recommendations for VTE prophylaxis, but they differ regarding the preferred pharmacologic modality and duration. Although the goal is to provide optimal patient care, lack of guideline consensus may lead to different postoperative recommendations. It is important for clinicians to discuss with their patients the pharmacologic options available for VTE prophylaxis, how organizations differ in their recommendations, and the limitations of these pharmacologic agents.

KW - anticoagulation

KW - aspirin

KW - pulmonary embolism

KW - total knee arthroplasty

KW - venous thromboembolism prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=85054809040&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054809040&partnerID=8YFLogxK

U2 - 10.1177/2150132718797446

DO - 10.1177/2150132718797446

M3 - Article

C2 - 30168355

AN - SCOPUS:85054809040

VL - 9

JO - Journal of primary care & community health

JF - Journal of primary care & community health

SN - 2150-1319

ER -