Platelet count, antiplatelet therapy and pulmonary embolism--a prospective study in patients with hip surgery.
Pulmonary embolism (PE) is a serious complication following hip surgery. Trials of antiplatelet thromboprophylaxis indicated a substantial reduction in PE rate, and we prospectively studied the effect of a combination of low-dose heparin and two different antiplatelets. Furthermore, our experience in previous studies suggested that platelet count (PC) levels could be useful to reliably suspect PE at a very early stage, and we prospectively tried to confirm our previous findings. Ours is a prospective study in 459 consecutive patients operated on because of hip fracture (265) or elective hip replacement (194), aimed to determine: 1) whether the benefits of antiplatelets plus heparin on PE outweigh the risks; 2) to assess the clinical usefulness of PC monitoring in these patients, so as to confirm whether PE could be recognized early. It was a prospective, randomized, double-blind study. All patients received unfractioned heparin (7500 IU sc twice daily, starting 2 h before operation). In addition, they received aspirin (200 mg thrice daily, with meals), Triflusal (300 mg thrice daily, with meals), or placebo. Real time B-mode ultrasonography (US) was performed on all patients on the 8-9th day after surgery. Venography was performed in patients with normal US, if clinical symptoms suggested venous thrombosis. Twelve out of the 459 patients (2.6%) had to discontinue prophylaxis, because of major bleeding (6 patients), or gastric intolerance (6 patients). There were no significant differences between groups in either deep vein thrombosis (26 patients (18%) with aspirin, 18 (12%) with Triflusal, 26 (17%) with placebo), or PE development (7 patients (5%) with aspirin, 3 (2%) with Triflusal, 8 (5%) taking placebo).(ABSTRACT TRUNCATED AT 250 WORDS)
Monreal
M
M
Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol de Badalona, Spain.
Lafoz
E
E
Roca
J
J
Granero
X
X
Soler
J
J
Salazar
X
X
Olazabal
A
A
Bergqvist
D
D
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006620:Hip Fractures / Q000097:blood / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010976:Platelet Count / Q000187:drug effects; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D011877:Radionuclide Imaging; D012459:Salicylates / Q000009:adverse effects / Q000627:therapeutic use*; D013924:Thrombophlebitis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome; D014463:Ultrasonography; D014839:Vomiting / Q000139:chemically induced
D010975:Platelet Aggregation Inhibitors; D012459:Salicylates; C016167:triflusal; D006493:Heparin; D001241:Aspirin