Perioperative low-molecular-weight heparin. Is it effective and safe.
In previous randomised clinical trials of thromboprophylaxis after total hip replacement, low-molecular-weight heparin has been given for an arbitrary 7 to 14 days. The risk factors are mainly perioperative and it is possible that a shorter course may be adequate. We assessed the safety and effectiveness of a three-day course. We assessed 156 primary THR patients after randomisation to either a control group or to receive enoxaparin at 12 hours preoperatively and 12 and 36 hours postoperatively. Thrombosis was diagnosed by routine venography. Haemorrhagic side-effects were assessed by measurement of blood loss, and soft-tissue side-effects by descriptive scores for wound discharge and bruising of the leg. The prevalence of calf thrombosis was 15.4% in the enoxaparin group and 32.1% in the control group (p = 0.01); the prevalence of proximal thrombosis was 15.4% and 17.9% respectively (not significant). There was no difference in haemorrhagic side-effects or wound discharge, but there was more bruising in the enoxaparin group.
Warwick
D
D
University of Bristol, England.
Bannister
G C
GC
Glew
D
D
Mitchelmore
A
A
Thornton
M
M
Peters
T J
TJ
Brookes
S
S
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001843:Bone Cements; D016009:Chi-Square Distribution; D003288:Contusions / Q000139:chemically induced*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D010690:Phlebography; D011474:Prosthesis Design; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000517:prevention & control*
D000925:Anticoagulants; D001843:Bone Cements; D006495:Heparin, Low-Molecular-Weight