Comparison of postoperative coumarin, dextran 40 and subcutaneous heparin in the prevention of postoperative deep vein thrombosis.
A double-blind study was carried out to investigate the effectiveness of several preventive regimens in postoperative deep vein thrombosis (DVT). The regimens consisted of postoperative (p.o.) acenocoumarin, dextran 40 + p.o. acenocoumarin, subcutaneous (s.c.) heparin alone and s.c. heparin + p.o. acenocoumarin. The 313 patients studied were stratified according to age (40-60 vs. less than 60 years) and type of operation (laparotomy, thoracotomy, hip replacement). Dextran 40 + p.o. acenocoumarin was more effective than p.o. acenocoumarin alone, which acted as control. Subcutaneous heparin alone or together with p.o. acenocoumarin was not more effective than p.o. acenocoumarin alone during the first part of the study, when about 4000 IU twice daily were administered accidentally. When the dose had been changed to 5000 IU twice daily, better results were obtained (DVT) incidence 5.9%). The results were strongly influenced by age and type of operation. Almost no DVT occurred in patients below 60 years of age with elective abdominal surgery. The incidence of perfusion disturbances in lung scans in patients with DVT was lowest in those treated with s.c. heparin in combination with acenocoumarin.
D000328:Adult; D000367:Age Factors; D000368:Aged; D002986:Clinical Trials as Topic; D003374:Coumarins / Q000627:therapeutic use*; D003911:Dextrans / Q000627:therapeutic use*; D004311:Double-Blind Method; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D006470:Hemorrhage; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007279:Injections, Subcutaneous; D007813:Laparotomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013903:Thoracic Surgery; D013909:Thorax / Q000601:surgery; D013924:Thrombophlebitis / Q000517:prevention & control*
D003374:Coumarins; D003911:Dextrans; D006493:Heparin