“As the rate of shoulder surgery continues to rise, so too will the prevalence of patients who can develop venous thromboembolism,” said lead study author and orthopaedic surgeon Catherine Rapp, MD. “Fortunately, recent studies offer more guidance on the management of VTE after shoulder surgery. While VTE after total hip and knee arthroplasty has been well-studied, historically, the literature regarding VTE after shoulder surgery has been lacking. This review aims to summarize the available evidence and recommendations regarding VTE after shoulder surgery.”
Dr. Rapp and her co-authors reviewed general literature that reported a wide range of VTE rates after shoulder surgery, including:
- Symptomatic VTE rates are higher after shoulder replacement (range, 0.24% to 2.6%) than after arthroscopy (range, 0.01% to 0.38%).
- Specifically, DVT rates are higher after shoulder replacement (range, 0.09% to 1.69%) than after arthroscopy (range, 0.01% to 0.38%) as are PE rates (range 0% to 3% versus 0% to 0.21%).
- Asymptomatic DVT rates after shoulder replacement were significantly higher than after arthroscopy at 13% versus 5.7%.
- While most VTE events occur within the first postoperative week, they can occur up to three months after surgery.
The standardized guidelines for VTE prevention after shoulder surgery are lacking, according to the literature review authors, despite potentially significant long-term risks. Low-risk measures, such as early mobilization and sequential perioperative compression devices (a method used to improve blood flow), should be utilized in all patients when feasible. And higher risk strategies, such as pharmacologic prophylaxis (blood thinners) should be tailored on an individual basis.
“Patients should be aware of their risk for VTE after shoulder surgery and have an open conversation with their doctor about how to reduce their risk,” explained Dr. Rapp. “These factors may include but are not limited to patients with expected significant reduction in mobility, active cancer or cancer treatment, age 60 years or older, obesity, significant medical comorbidities such as diabetes and heart disease, and personal or family history of VTE. Patients should also pay attention to symptoms after surgery and weigh risks and benefits of treatment options with their physician.”
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