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How To Prevent Blood Clots After Knee Surgery

Treatments For Blood Clot After Surgery

Preventing Blood Clots After Orthopaedic Surgery

Your doctor will use different treatment approaches mainly to limit the growth of the blood clot. Prompt treatment greatly reduces the risk of experiencing serious complications.

1. Medications

  • Blood thinners: Your doctor may prescribe a blood thinning medication to break up the clots while preventing new clots. Heparin is a common choice and is usually given with an oral anticoagulant such as warfarin. New medications are now available that work efficiently without interacting with other medications.
  • Clot dissolvers: Your doctor may give you thrombolytics or clot dissolvers through the vein. They help dissolve clots quickly. These medications are usually the last resort and are given in life-threatening situations because they have the risk of causing sudden and severe bleeding.

2. Surgery and Procedure

  • Clot removal: Surgical removal of clots is an option when you have a very large clot in your lung. Your doctor will remove it through a flexible tube threaded through the blood vessels.
  • Vein filter: The procedure involves using a flexible tube to position a filter into your body’s main vein. It helps prevent clots from entering your lungs. It is an effective treatment option but is usually suitable for people who have problems taking anticoagulant drugs.

Blood Clot Signs And Symptoms

While you are recovering from your joint replacement surgery, be on the lookout for possible blood clots and contact your physician immediately if you experience any of the signs or symptoms of a blood clot.

Symptoms of Deep Vein Thrombosis

  • Swelling, usually in one leg
  • Pain or tenderness not caused by an injury it often feel like a leg cramp that will not go away
  • Skin that is warm to the touch
  • Redness in skin

If you experience any of these symptoms, call a doctor as soon as you can.

Symptoms of Pulmonary Embolism

  • Difficulty breathing
  • Chest or back pain that worsens with a deep breath
  • Coughing, or coughing up blood

A PE can be fatal, if you experience any of these symptoms, call 9-1-1 or seek immediate medical attention.

NBCAs Stop the Clot® THA/TKA Patient Toolkit was made possible by an educational grant provided by Janssen Pharmaceuticals, Inc.

Can A Dvt Be Prevented

After you have a DVT, you will need to reduce your risk of future clots by:

  • Taking your medications exactly as your doctor tells you to.
  • Keeping your follow-up appointments with your doctor and the laboratory. These are needed to see how well your treatment is working.

If you have never had a DVT , but have an increased risk of developing one, be sure to:

  • Exercise your lower leg muscles if you need to sit still for a long time. Stand up and walk at least every half hour if you are on a long flight. Or get out of the car every hour if you are on a long road trip.
  • Get out of bed and move around as soon as you can after you are sick or have surgery. The sooner you move around, the less chance you have of developing a clot.
  • Take medications or use compression stockings after surgery to reduce your risk of a clot.
  • Follow-up with your doctor as directed to and follow your doctors recommendations to reduce your risk of a clot.

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Why Blood Clots Develop After Surgery

Blood clots can develop for a couple of different reasons as a result of surgery. Long procedures where you are inactive can allow your blood to pool, providing an ideal environment for the formation of a clot. The same can be said after an operation where patients cant be as active because of the physical trauma of an operation. Thats why Dr. Botero and other joint replacement surgeons are so keen on getting patients up and moving shortly after a procedure to greatly reduce clot risk.

Blood clots can also be more likely after joint replacement operations due to the nature of the operation. When bone needs to be shaved or cut, your body can release a substance known as antigens. These antigens in turn trigger an immune response from your body, which can increase your risk of a clot.

A clot can also develop if you have familial or lifestyle factors that increase your propensity for clots. For example, if you have a family history of blood clots, are a smoker or youre overweight, youre already at a higher risk for clot development, so taking prevention steps is even more important.

What Is The Research Team Doing

How to Avoid Blood Clots After Surgery

The research team is recruiting 25,000 patients who are having hip or knee replacement surgery at one of 25 medical centers across the United States. The team is assigning patients by chance to get one of three medicines that are commonly used to prevent blood clots after surgery.

The research team is comparing how many patients in each of the three groups

  • Have bleeding problems
  • Return to the hospital because of a blood clot in their leg or lung
  • Die, even if their death is not related to a blood clot

The research team formed a patient advisory board of people who had had hip or knee replacement surgery. The board includes people who had problems after surgery. The board is helping the research team to understand patients views on the benefits and harms of blood thinners.

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Information For Patients About Blood Clot Prevention

How Do I Prevent Blood Clots?

Blood clots claim more over 100,000 lives yearly in the United States. Yet as serious a health issue as blood clots are, studies have shown at-risk patients often dont receive treatments known to help prevent them.

The Johns Hopkins Venous Thromboembolism Collaborative has developed a video and an educational handout to better engage patients and their loved ones as partners in preventing blood clots.

The handout is also available in:

Content from the handout is adapted below.

Aspirin Was Noninferior To Anticoagulants

Surprisingly, aspirin was just as effective as drugs like rivaroxaban , warfarin or low-molecular-weight heparin. Doctors have a strange way of saying that. They love to use the word noninferior. The authors concluded that:

In this study of patients undergoing TKA , aspirin was not inferior to other anticoagulants in the postoperative rate of VTE or death.

In normal English, they found that regular old aspirin was comparable to anticoagulant drugs such as the aforementioned Xarelto, apixaban , argatroban , edoxaban or dabigatran .

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How To Avoid Blood Clots After Surgery

The most common type of blood clot is called a deep vein thrombosis and forms in the deep veins of your body, usually in the lower leg. A pulmonary embolism forms when a blood clot from somewhere in the body dislodges, travels to your lungs, and causes a blockage in one of the arteries of your lungs. This can cause serious complications and is life threatening.

Signs of a DVT in the lower leg include swelling, change in color, warmth, itching, and pain. Signs of a PE include shortness of breath and trouble breathing, chest pain, coughing, sweating, and dizziness.

After surgery, you are at an increased risk for blood clots because you are less mobile. Your legs and muscles are not working as much and a significant proportion of your time is spent lying in bed. This leads to stagnation of the blood in your veins. The flow of blood is slower and less blood is being pumped back to the heart. This makes it easier for blood clots to form.

Aspirin A Good Clot Buster After Knee Replacement

DVT (deep vein thrombosis) aka blood clot after total knee replacement

HealthDay Reporter

WEDNESDAY, Feb. 21, 2018 — Good old aspirin is just as effective as newer, expensive drugs at preventing blood clots after hip or knee replacement, a new clinical trial suggests.

Researchers said the findings could change some doctors’ prescribing habits.

After knee or hip replacement surgery, there’s a risk of blood clots in the legs or lungs. So it’s routine for patients to take clot-preventing drugs for some time afterward.

Right now, some doctors choose powerful anti-clotting drugs like dabigatran and rivaroxaban , said Dr. David Anderson, the lead researcher on the new trial.

But it hasn’t been clear whether those expensive prescription drugs are any better than cheap, readily available aspirin, explained Anderson, of Dalhousie University, in Halifax, Canada.

Based on the new findings, they’re not.

Few patients in the study developed a blood clot after surgery, and those on aspirin fared just as well as those on rivaroxaban.

The caveat, Anderson said, was that all study patients received rivaroxaban for the first five days after surgery. After that, they either continued on the drug or switched to aspirin for another nine to 30 days.

“From this study, we have no evidence to support starting aspirin on day one,” Anderson said.

But after day five, he added, “it’s very reasonable to consider switching to aspirin.”

Gonzalez Della Valle specializes in hip and knee surgery at the Hospital for Special Surgery in New York City.

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Preventing Blood Clots After Surgery

There are several things you can do to prevent blood clots after surgery. The most important thing you can do is discuss your medical history with your doctor. If you have a history of blood clots or are currently taking drugs or medications, you should inform your doctor.

Some blood disorders can lead to problems with clotting and cause problems after surgery. Taking aspirin has also been shown to help with blood clots, so starting an aspirin regimen can be helpful.

Your doctor may prescribe warfarin or heparin, which are common blood thinners. Blood thinners, or anticoagulants, are used to treat excessive blood clotting. They can also help any clots you currently have from getting bigger.

Before surgery, your doctor will take all of the necessary precautions to prevent blood clots. After surgery, they will make sure that your arms or legs are elevated, to help increase circulation.

If you have a high risk of clots, your doctor may observe and monitor you using serial duplex ultrasound scans. Clot-dissolving medications called thrombolytics may be used if you have a high risk of pulmonary embolism or deep vein thrombosis . These medications are injected into your bloodstream.

Lifestyle changes prior to surgery may also help. These may include quitting smoking or adopting an exercise program.

Blood Clot Risk Factors

Some patients have an increased risk of getting DVT following ankle surgery. Some of the most common risk factors include:

  • A Body Mass Index of over 40
  • A medical history that includes blood clots
  • A cigarette smoker
  • Currently receives cancer treatments

Other risk factors may include taking certain types of birth control and having a family history of blood clots. For patients with these risk factors, an orthopedic surgeon may prescribe blood thinners to lessen the chances of developing DVT following surgery.

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What Can Cause Knee Pain Years After A Knee Replacement

Knee replacements dont last forever. Most knee replacements perform well and cause no issues to patients for 10 to 20 years after the operation. When pain occurs years after knee replacement, its typically due to one of these four knee replacement problems after 10 years or more.

  • Soft tissue irritation around the knee The most common pain patients experience that occurs years after a knee replacement will be the soft tissue around the knee. Patients still have multiple tendons, ligaments, and muscles around the knee that may become irritated with varying activities.
  • The implant becomes loose A loosening implant is a cause of pain that can occur years after knee replacement surgery. A loosening implant is typically caused by wear and tear over time, though it can be exacerbated by high-impact sports or obesity. A loosening implant can cause pain as well as instability in the knee and a change in the alignment of the knee joint.
  • Infection The infection rate after knee surgery is very low, around 1 percent. If an infection does set in around the components of the knee replacement, it can be difficult to treat with antibiotics. Revision surgery may be necessary to get the infection under control.

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Prevention And Treatment Of Blood Clots After Hip And Knee Replacement Surgery

Prevention and Treatment of Blood Clots after Hip and Knee Replacement ...

Taking steps for the prevention and treatment of blood clots after hip and knee replacement surgery is an important part of your recovery. Joint replacement patients are at highest risk for developing a DVT two to 10 days after surgery, and remain at risk for approximately three months.To prevent the occurrence of a blood clot, your doctor will likely prescribe a combination of treatment approaches for you, which may include:

  • Exercise/physical therapy beginning the first day after surgery and continuing for several months
  • Compression stockings
  • Anti-clotting medicine to reduce the bodyâs ability to form blood clots

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Aspirin May Be A Follow

This is a plain English summary of an original research article

In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug.

Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the risk of blood clots in the legs or lungs.

This trial included over 3,000 adults who received rivaroxaban for the first five days after surgery and then either continued with the drug as is current practice or switched to aspirin.

The findings suggest that aspirin is an equally safe and effective alternative after initial rivaroxaban prophylaxis, though the chance of a clot or bleeding was small for both strategies. Aspirin is a cheap drug, and that could reduce costs of prevention if patients are switched to it after five days, by when most are discharged. Aspirin is not licensed for this use, but NICE 2018 guidelines recommend it as an option.

Its unclear if these results would apply to groups with a higher risk of thrombosis.

Cleveland Clinic Heart Vascular & Thoracic Institute Vascular Medicine Specialists And Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:

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Treating And Preventing Blood Clots After Injury

Any time you have a painful injury, even if you dont think you have a fractured bone or sprain, see a physician for an evaluation. Most bruises dont require treatment beyond ice packs for the first 24-48 hours, followed by heat as needed to alleviate discomfort. However, a medical evaluation will rule out any other serious injuries and help ensure healing.

Its even more important to see a doctor as soon as possible if you have any signs of a blood clot after a bruise. Imaging tests, including ultrasounds, MRI, and CT scans, can identify blood clots both deep within the tissues and organs, as well as in or near blood vessels.

When a doctor finds a blood clot, treatment typically involves blood-thinning medications, and in some cases, surgical removal of the clot. You may need to continue taking medication to prevent future clots, as well.

If you are injured and develop a bruise, following your doctors instructions for applying ice and heat is one of the best ways to prevent a blood clot from forming. Movement is also essential, especially when you have a leg injury. Getting up and moving around every hour, even for a few minutes, can help increase circulation and prevent blood clots. Staying hydrated and avoiding alcohol also help reduce the risk of a medical emergency.

How Do You Know If You Have A Blood Clot After Surgery

Dr. Michael Miranda Discusses How to Prevent Blood Clots After Surgery

The incidence of asymptomatic deep venous thrombosis or blood clot reportedly ranges from 30 to 80%. The incidence for asymptomatic DVT ranges from 0.5% to 4%. There are numerous items that play a role in potential DVT development. The type of surgery, family history, past medical history, and weight are just a few of the factors that are at play in potential DVT development.

So, what are some of the signs and symptoms that may indicate a blood clot has developed following surgery? A DVT following surgery can cause leg pain or tenderness. The leg could be swollen or feel warm to the touch. One could have discoloration of the skin or redness present. The veins just under the skin could be more prominent or stick out.

The first indication of a blood clot following surgery could symptoms of sudden chest pain or pain with breathing. You could be short of breath. You may even cough up blood. These symptoms are related to the blood clot moving to your lungs. This is medically called a pulmonary embolism or PE.

If at any time in your postop recovery you are concerned about a possible blood clot, you need to contact your primary healthcare provider or the Center for Vascular Medicine. After a thorough discussion of your concerns and possibly a physical examination, a determination for additional studies will be made. A DVT can be life-threatening. One should never take a wait-and-see approach to such a problem. Please seek immediate medical attention.

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