Abstract
There is no consensus on the management of the most lethal complication of total joint replacement. One school follows the traditional ‘prophylaxis without compromise’ policy, while the other, realising the dangers of prophylactic drugs, especially in total joint replacement, goes to the other extreme of ‘no prophylaxis and no anti-thrombotic drugs even for pulmonary embolism’.
We follow a middle of the road principle, believing that ‘surveillance determines anticoagulation therapy’. Our treatment protocol divides patients into high and low-risk cases. Regular surveillance (Doppler and blood examination) determines the method and extent of prophylaxis for high-risk cases and the therapeutic handling of positive clot formation in low-risk patients. Treating over 1055 patients over 8 years, we selectively administered anticoagulants only when clinically indicated and after positive Duplex diagnosis. Mortality due to pulmonary embolism was reduced by this regime from 1.0% to less than 0.05% (two cases in 6 years).
Guidelines have been laid down regarding the value of blood tests in combination with Duplex in an effective and affordable way, not only to detect thrombo-embolism but also to manage treatment, even after discharge.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
