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MTHFR mutation has no impact on thromboembolism risk
14%
459/3277
Intraoperative conversion from spinal to general anesthesia increases thromboembolism risk
58%
1897/3277
Post-operative anemia treated with erythropoietin decreases thromboembolism risk
5%
166/3277
Oral tranexamic acid use increases thromboembolism risk
448/3277
Post-menopausal estrogen use is protective from thromboembolism
8%
248/3277
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General anesthesia carries an increased risk of thromboembolism compared to spinal anesthesia. The remaining statements are false. There have been multiple factors that demonstrate an increased risk of venous thromboembolism (VTE). Some of these risk factors include a previous VTE, obesity (BMI > 30), surgery type (i.e. total joint arthroplasty), hypercoagulable states (i.e. cancer, inheritable traits), myocardial infarction (MI), congestive heart failure, family history of VTE, hormone replacement therapy, elevated hormone conditions, varicose veins, and general anesthesia (increased risk compared to epidural/spinal anesthesia). Current AAOS guidelines recommend mechanical prophylaxis in all total hip and knee arthroplasty patients and chemoprophylaxis is recommended, but no optimal regimen is recommended. Chemical prophylaxis should be individualized for each patient and their risk factors. Geerts et al. put forth their recommendations on the prevention of VTE from the American College of Chest Physicians in 2008. Some of the important points include aspirin not being recommended as a monotherapy (this recommendation was changed in 2012 and is now accepted as monotherapy), recommendation for mechanical prophylaxis, and recommendation for routine chemoprophylaxis for elective hip and knee arthroplasty for a minimum of 10 days. Caprini et al. retrospectively reviewed 939 patients with either a DVT, PE, or PE and DVT and their treatment. They found that there was lower than anticipated use of low molecular weight heparin, insufficient bridging of patients to warfarin, and insufficient continuation of anticoagulation following hospitalization. They concluded that hospitals need to re-evaluate adherence to VTE treatment guidelines and develop strategies to optimize therapy. Incorrect Answers: Answer 1: MTHFR mutation carries one of the highest risks of thromboembolism. Answer 3: The use of erythropoietin increases the risk of thromboembolism. Answer 4: Oral tranexamic acid use has not been shown to increased the risk of thromboembolism. Answer 5: Hormone replacement therapy increases the risk of thromboembolism.
2.6
(5)
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