Prevention of symptomatic pulmonary embolism in patients undergoing total hip and knee arthroplasty: clinical guideline of the American Academy of Orthopaedic Surgeons.

A work group of the American Academy of Orthopaedic Surgeons, with the assistance of the Center for Clinical Evidence Synthesis at Tufts-New England Medical Center, has proposed a guideline for the prevention of symptomatic (and fatal) pulmonary embolism in patients undergoing total hip and knee arthroplasty. This guideline includes recommendations from both a consensus process and an analysis of 42 publications since 1996. The end points included symptomatic and fatal pulmonary embolism rates, total death rates, and major bleeding complications. The guideline recommends preoperative evaluation of all patients for "standard" and "high" risks of both pulmonary embolism and major bleeding complications. The use of regional anesthesia, mechanical prophylaxis, rapid mobilization, and patient education were consensus recommendations. The choice of a specific medication postoperatively should be based on an individual risk-benefit analysis of pulmonary embolism and major bleeding complications.