DVT Prophylaxis
In the absence of reliable evidence, it is the opinion of this work group that physicians use peri-operative mechanical and/or chemical VTE (venous thromboembolism) prophylaxis for shoulder arthroplasty patients.
CONSENSUS RECOMMENDATION Rationale
Venous thromboembolism and pulmonary embolism are recognized potentially catastrophic complications faced by all patients who undergo shoulder arthroplasty. Despite the paucity of evidence to support or refute the use of embolic prophylaxis in shoulder arthroplasty patients, the consensus opinion of our work group is to employ its routine use. Mechanical prophylaxis for shoulder arthroplasty patients intra-operatively and during the immediate postoperative period places the patient at minimal additional risk or discomfort and may help prevent pulmonary embolism. Each patient should be assessed for the risk of pulmonary embolism and the addition of chemical prophylaxis considered if appropriate. The level of embolic risk must be weighed against the potential bleeding risk in these patients as well. We believe these actions are consistent with the current practice of most Orthopaedic surgeons. The AAOS has produced a guideline for the prevention of pulmonary embolus in lower extremity surgery, which can also serve as a reference; however, the risks for lower extremity surgery are reported to be higher than shoulder surgery.28 As such these guidelines may not be applicable to this patient population.