The effect of intraoperative intravenous fixed-dose heparin during total joint arthroplasty on the incidence of fatal pulmonary emboli

All patients who underwent primary total knee arthroplasty (TKA), revision TKA, primary total hip arthroplasty (THA), and revision THA between January 1, 1990, and December 31, 1996, were retrospectively reviewed to determine the incidence of fatal pulmonary emboli. All TKA patients received 1,000 U of intravenous heparin sodium before the tourniquet was inflated and an additional 500 U of intravenous heparin sodium before the inflation of the second tourniquet during bilateral TKA. All THA patients received 1,000 U of intravenous heparin sodium at the time of the skin incision and 500 U of intravenous heparin sodium before preparation of the femoral canal. The overall incidence of fatal pulmonary emboli was extremely low (TKA, 0.096%; THA, 0.16%). With this regimen of intravenous intraoperative heparin, postoperative aspirin, thromboembolic disease hose, and early ambulation, there is no risk of postoperative bleeding, it is inexpensive, and there is no concern on how long to keep the patients on this regimen postoperatively. We recommend this regimen for the prevention of fatal pulmonary emboli after total joint arthroplasty.