Your Doctor's Choice of a Therapeutic Anti-Coagulant Could Be The Difference Between Life and Death Following a Hip or Knee Replacement Surgery

As the United States' population continues to age, more and more people are requiring what are called total hip arthroplasties (THA) or total knee arthroplasties (TKA). In short, total hip replacements or total knee replacements. What many people do not realize is that the most dangerous part about these procedures is not the surgeries themselves, but the several days and weeks thereafter, when many of these patients carry a significant risk of developing a blood clot or pulmonary embolism that could seriously harm or kill them. As a result, these patient's physicians must carefully tailor what are known as anti-coagulation regimens for each patient so as to effectively minimize the risk that their patients will develop a blood clot or pulmonary embolism. So how do they do it? First some background.

Normally, when an injury or surgical procedure causes bleeding to occur, the body sends out a signal that causes the blood to clot at that site. Blood clots typically form on the insides of someone's blood vessels in one of two locations: the hips (called a proximal clot) or the deep veins of the calves (called a distal clot or deep vein thrombosis) (DVT). Patients who undergo orthopedic procedures on the knees, hips and spine are generally known to have an increased risk of developing a blood clot due to the immobility associated with these procedures and rehabilitation process. If one of these blood clots breaks off and travels to the lungs, it can lodge in the branches of the lungs, causing shortness of breath, a lack of oxygen to the brain, strokes, and even death. A blood clots that breaks off and travel to the lungs are known as pulmonary embolism, or PE for short.

Some people because of their genetic make up or their unique medical history are more prone to developing blood clots than others. This means that they have an imbalance in their body between the chemicals that promote clot formation and clot breakdown. For example, some people have certain proteins in their blood stream that make them more prone to developing clots. Age and obesity are also recognized risk factors for developing a blood clot. Anyone who has developed a blood clot in the past is considered to be at an elevated risk of developing a blood clot in any subsequent surgical procedure.

Because of the generalized risk of developing blood clots after a TKA or THA, all patients are typically placed on a regimen of blood thinners known as anti-coagulants to minimize the risk of the blood clotting. Like most medications, blood thinners range in terms of their potency. For example, aspirin is the least potent blood thinner in terms of how quickly it becomes therapeutic. Other blood thinners include heparin, low molecular weight heparin (known as Lovenox) that can be injected at home, Coumadin (Warfarin), or Xarelto. Some of these blood thinners might be prescribed for days, others for weeks or months. So what determines which blood thinner you should be prescribed?

Every physician will tell you that the decision on what anti-coagulant/blood thinner a patient is prescribed depends upon a risk/benefit analysis; i.e., the risk of the patient developing a clot versus the risk that the blood thinning medication might cause the patient to bleed excessively post-operatively (also a big danger). As a result, the physician must know (from the patient's medical history) whether or not the patient carries an elevated risk of bleeding (i.e., are they a hemophiliac? Do they have a blood or liver disorder that might cause them to bleed more than someone who doesn't have those conditions post-operatively?).

The end result is that if a patient has an elevated risk of clotting (i.e., they have a number of risk factors for developing a clot like a history of clots, age, obesity, etc.) but they have a standard risk of bleeding (no risk factors), a stronger blood thinner should be prescribed for the patient to minimize the risk of clotting. Conversely, if a patient has a standard risk of clotting but an elevated risk of bleeding, a weaker blood thinner should be prescribed at least initially following the surgery.

At Silverman Thompson Slutkin & White, our lawyers have routinely handled cases in which patients have been severely injured or died following a TKA or THA for the simple reason that the physician negligently prescribed a blood thinning medication that was not therapeutic for that particular patient based upon their individual risk factors. If you or a loved one has been injured or died following an orthopedic surgical procedure as the result of a blood clot or pulmonary embolism, call our team for a free consultation at 410-385-2225.