Woman Dies From Pulmonary Embolism After Knee Arthroplasty

Case Overview

This case involves the postoperative care of a woman who underwent a right total knee arthroplasty. The medical note indicates that the patient experienced left lower leg chronic swelling from radiation treatment several years back and also mentioned that she had a history of deep vein thrombosis for the past 20 years which was treated using Xarelto. Four days after surgery, the patient experienced a severe episode of respiratory distress and decompensated rapidly from that point onward until her imminent death. The medical record shows that the patient was not given anticoagulation during her hospital stay and was also not monitored well as a high-risk patient for possible DVT formation. An autopsy was not performed, but the cause of death is listed as cardiogenic shock, bilateral pulmonary emboli, and lower extremity DVT.

Questions to the Orthopedic Surgery expert and their responses

What is an adequate anticoagulation protocol for a post-operative patient who has a significant past medical history of DVTs?

There seems to be a significant departure from recommended standards of care with regard to risk assessment and appropriate DVT/PE prophylaxis in a high risk situation. At a bare minimum this patient's significant history of DVTs in the past warrants a close monitoring of her status and the doctors on her case should be on high alert for impending clots.

About the expert

This expert is board certified in Surgery and has additional fellowship training in Sports Medicine. He was trained at New York College of Medicine at the Hospital for Special Surgery, and is currently in active practice at a major medical center in New York City where he performs arthroscopic procedures on a daily basis. Finally, he is the chief consulting orthopedic physician for a major sports rehabilitation center in the northeast.