HSS Team Digs Into Likelihood Of VTE Before TJA
Orthopedics This Week (OTW) reports on an ongoing study by Alejandro Gonzalez, Della Valle, MD, hip and knee surgeon at HSS, reviewing the safety and efficacy of multimodal thromboprophylaxis (MMP) in patients with a history of venous thromboembolism (VTE) undergoing total hip arthroplasty (THA).
OTW spoke to Dr. Della Valle to discuss the methodology, who said, “In this study we are looking at a consecutive group of patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) before undergoing primary hip replacement. We gave them an anticoagulant after surgery and set out to determine the risk of a new PE, DVT, a bleed, or dying during the first year after surgery.”
Dr. Della Valle commented on initial findings, noting, “While recognized risk factors for PE include morbid obesity and active cancer, the most recognizable risk factor is a prior history of DVT or PE. However, the decision to anticoagulate a patient after surgery is sometimes complex, as some have hidden risk factors for VTE that remain unknown unless they can be tested. There are patients who carry gene mutations that predispose them to DVT or PE. Interestingly, these are the same gene mutations that predispose women to having recurrent inexplicable miscarriages. Since genetic testing is not cost effective, it cannot be offered to all patients.”
Additionally, Dr. Della Valle concluded, “The most important lesson from our work is that you have to ask all patients if they have a personal history of thromboembolic disease, how they developed the PE or DVT (was it associated with other diseases or did it arise spontaneously, the latter of which raises concern for the underlying presence of a genetic predisposition). Have that conversation with patients…ask if anyone in the family has had a DVT or PE and ask if they have a female relative who has had recurrent inexplicable miscarriages.”
Read the full article at ryortho.com.