title: Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty.
abstract: Intraoperative, fixed, intermittent, low-dose intravenous heparin prophylaxis has been reported to significantly reduce the incidence of thromboembolic disease from 24.3% to 8.3% after primary total hip arthroplasty (THA). This study examined the potential efficacy of adjusted-dose intraoperative heparin administration, keeping the activated clotting time at 30%-50% greater than normal. It was hypothesized that prolongation of clotting parameters in a uniform manner would further decrease the incidence of thromboembolic disease postoperatively. Sixty-one patients completed the protocol. The overall incidence of thromboembolic disease was 9.8%. Five patients had a positive postoperative venogram: four in the calf and one in the proximal deep thigh vein. One patient had a symptomatic nonfatal pulmonary embolus diagnosed by ventilation-perfusion scan. There were no complications related to heparin administration. This approach was therefore equally as effective as the fixed-dose regimen, and it further confirmed the efficacy and safety of an intraoperative heparin prophylaxis regimen. The extra efforts required to maintain a constant intraoperative level of anticoagulation did not prove advantageous over the simpler, fixed-dose regimen in reducing the incidence of thromboembolic disease after primary THA.
authors.affiliation: Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, D.C.
authors.forename: M H
authors.initials: MH
authors.lastname: Huo
authors.forename: E A
authors.initials: EA
authors.lastname: Salvati
authors.forename: N E
authors.initials: NE
authors.lastname: Sharrock
authors.forename: P M
authors.initials: PM
authors.lastname: Pellicci
authors.forename: T P
authors.initials: TP
authors.lastname: Sculco
authors.forename: G
authors.initials: G
authors.lastname: Go
authors.forename: R
authors.initials: R
authors.lastname: Mineo
authors.forename: W W
authors.initials: WW
authors.lastname: Brien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006622:Hip Prosthesis; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013923:Thromboembolism / Q000517:prevention & control*; D014914:Whole Blood Coagulation Time
chemical_list: D006493:Heparin