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Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER)

Supported by funding from the Patient Centered Outcomes Research Institute (PCORI)


Nearly one million total hip and knee replacements are performed each year in the United States. Because disturbing the bone marrow cavity turns on the blood clotting system in humans, these operations can be complicated by formation of blood clots in the veins of the leg (deep vein thrombosis). These clots sometimes detach from the leg veins and travel to the lungs (pulmonary embolism, PE) where they interfere with the normal pumping of the blood from the heart. When a large clot gets stuck in the lung, it can result in death. The use of blood thinners around the time of operation reduces the risk of PE, but increases the risk of bleeding from the raw bony surfaces that are created when the joint replacement is done. The ideal balance between use of blood thinners to prevent PE and the risk of bleeding associated with their use is unknown.

The purpose of the study “Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER)” which is funded through a Patient-Centered Outcomes Research Institute (PCORI) award, is to combine information about effectiveness in preventing blood clots in the lungs and legs with the opinions of patients about the safety of the most commonly employed blood thinners. This work will provide background information to help both patients and their surgeons in deciding which blood thinner would be best to use after hip and knee replacement.

In order to generate enough data to achieve the purpose of PEPPER, approximately 25,000 patients undergoing elective total hip or knee replacements will be enrolled at 25 centers over a period of 3.5 years. The study will encompass five years, with six months startup, six months follow-up per patient, and six months for final data analysis. The principal investigator is Vincent Pellegrini, M.D, John A. Siegling Professor and Chair of the Department of Orthopaedics at the Medical University of South Carolina. Learn more about our PEPPER study.

PEPPER is also registered on

Clinical Consortium

The PEPPER trial will enroll 25,000 patients across 25 sites in North America. To learn how to participate, please contact the program manager, Carol Lambourne at 843-792-2913 or You may also contact a site principal investigator at a participating institution near you from the list below.

Institution State Institution PI PI Email
Anderson Orthopaedic Institute VA Kevin Fricka
Cleveland Clinic OH Michael Mont
Dartmouth - Hitchcock Medical Center NH Wayne Moschetti
Duke University Medical Center NC Michael Bolognesi
Geisinger Medical Center PA Michael Suk
Johns Hopkins University MD Robert Sterling
Lahey Clinic MA Michael Kain
Larkin Community Hospital FL Carlos Lavernia
London Health Sciences Centre ONT Brent Lanting
Mayo Clinic MN Kevin Perry
Mayo Clinic Arizona AZ Mark Spangehl
Medical University of South Carolina SC Richard Friedman
Midwest Orthopaedics at Rush IL Scott Sporer
New York University NY Richard Iorio
Penn State Hershey Medical Center PA Charles Davis
Sinai Hospital, Baltimore MD James Nace
Stanford University Hospital CA William Maloney
University of Arkansas for Medical Sciences Hospital AR C. Lowry Barnes
University of California, Los Angeles CA Bert Thomas
University of Nebraska NE Kevin Garvin
University of Pennsylvania PA Charles Nelson
University of Virginia VA James Browne
University of Washington Medical Center WA Navin Fernando
Virginia Commonwealth University Medical Center VA William Jiranek
West Virginia University WV Brock Lindsey

The Patient-Centered Outcomes Research Institute (PCORI) is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work.

For Investigators

PDFs, Forms, Reports, Audio, and Video for site investigators, trial coordinators, and other staff at sites.
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