A case of pulmonary embolism after orthopedic surgery
Pulmonary embolism is a life-threatening condition that should be promptly recognized. Surgical patients are at increased risk of developing a PE, especially after orthopaedic hip and knee surgery, because of positioning during surgery and immobility, that contributes to an increase in venous stasis. Therefore the prophylactic therapy is essential. Despite standard thromboprophylaxis, symptomatic PE can occurred. A study on patients at large tertiary care hospital showed a PE in 14% of cases undergoing total knee replacement, higher than other previous studies, with a lower rate of PE using enoxaparin (4). Nowadays we have further to traditional therapy with enoxaparin twice a day and fondaparinux once a day, also new oral anticoagulants, such us dabigatran etexilate (220 mg or 150 mg once daily), an oral direct thrombin inhibitor, that are useful not only in the prevention, but also in the treatment of EP after orthopedic surgery, without significant differences and with a similar safety profile during treatment and follow up (5-7). Therefore dabigatran results not inferior to standard therapy with the benefit of a “single drug approach”, that in selected cases, can also guarantee a faster management at home.
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