[Peri- and postoperative use of low molecular weight heparin in peripheral vascular surgery].
A pilot study has been conducted in ten consecutive patients undergoing femoro-popliteal reconstruction or distal vascular surgery under epidural anaesthesia. Immediately before arterial cross-clamping, enoxaparin (E) (75 anti-Xa IU.kg-1) was injected intravenously (i.v.). During surgery, washing of the saphenous or polytetrafluoroethylene (PTFE) graft has been performed using enoxaparin. Enoxaparin (75 anti-Xa IU.kg-1) was administered subcutaneously (S.C.) 8 hours after the i.v. injection, and then every 12 hours during 10 days. The patency of the vascular reconstruction and the side-effects of E administration were evaluated clinically before and during surgery, then by a daily clinical examination. Echo-Doppler and/or arteriography were also performed preoperatively and on the 10th postoperative day. Haematocrit, platelet count, activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and anti-Xa activity were assessed. None of the patients developed venous or arterial thrombosis and all the by-pass grafts remained patient. Only one minor surgical bleeding occurred on the first post operative day, despite anti-Xa levels in the expected range. One patient developed minor haematomas at the injection site. No bleeding was observed. Further randomized studies comparing LMWH and UH are required in order to substantiate these preliminary clinical and biological findings.
Samama
C M
CM
Service d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Mouren
S
S
Bridel
M P
MP
Combe
S
S
Koskas
F
F
Kieffer
E
E
Viars
P
P
D000368:Aged; D000767:Anesthesia, Epidural; D001780:Blood Coagulation Tests; D001807:Blood Vessel Prosthesis; D005263:Femoral Artery / Q000601:surgery; D005340:Fibrinogen / Q000032:analysis; D006400:Hematocrit; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care; D010865:Pilot Projects; D010976:Platelet Count; D011150:Popliteal Artery / Q000601:surgery; D011182:Postoperative Care; D013927:Thrombosis / Q000517:prevention & control
D006495:Heparin, Low-Molecular-Weight; D005340:Fibrinogen
Utilisation per et postopératoire d'une héparine de bas poids moléculaire en chirurgie vasculaire périphérique.