Antithrombin III/low-dose heparin in the prevention of deep-vein thrombosis after total knee arthroplasty. A preliminary report.
This preliminary report outlines the rationale for a new approach to deep-vein thrombosis (DVT) prophylaxis in total knee arthroplasty (TKA) patients and describes preliminary hematologic and venographic findings. A protocol was employed to (1) document a series of hematologic events surrounding cemented TKA and the alterations of these events by the study drugs and (2) compare the safety and efficacy of a regimen of antithrombin III/low-dose heparin (ATIII/LDH) to that of low-molecular-weight dextran (LMWD) in the prevention of DVT after TKA. Using a dosage regimen of 3000 units of ATIII as a loading dose followed postoperatively by 2000 units daily combined with 5000 units of LDH twice daily, a prospective randomized study of patients treated by cemented TKA was performed. The ATIII/LDH regimen was compared with LMWD (10 ml/kg x 12 hours loading dose followed by 7 ml/kg x 24 hours maintenance dose). The rate of DVT after TKA in 42 patients was 25% (5/20) for the ATIII/LDH group versus 82% (18/22) for the LMWD group (p less than 0.001). Bleeding complications were minimal and comparable for each group. Hematologic studies demonstrated that quantitative and functional ATIII levels decreased after TKA and that preoperative loading with ATIII prevented levels from falling below 100%. Studies of clot formation (fibrinopeptide A) and plasmin activity (fibrinopeptides B beta 15-42 and 1-42) in 34 patients suggest some reduction in procoagulant activity in patients in the ATIII/LDH group. These findings indicate that the combination of ATIII and LDH may offer superior protection from DVT than does LMWD.
Stulberg
B N
BN
Cleveland Clinic Foundation, Ohio 44106.
Francis
C W
CW
Pellegrini
V D
VD
Miller
M L
ML
Shull
S
S
deSwart
R
R
Easley
K
K
Totterman
S
S
Marder
V J
VJ
D000990:Antithrombin III / Q000627:therapeutic use*; D003911:Dextrans / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007720:Knee Prosthesis; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013924:Thrombophlebitis / Q000517:prevention & control*
D003911:Dextrans; D000990:Antithrombin III; D006493:Heparin