[Prevention of thromboembolism in hip fracture: unfractionated heparin versus low molecular weight heparin ( a prospective, randomized study)].
In a prospective, randomized study in patients with hip fracture we discuss whether a single dose of low-molecular-heparin (Sandoparin) has the same effect as a tripple dose of standard-heparin (Liquemin: 3 x 5000 I.E.) The first dose of low-molecular-heparin respectively standard-heparin is given in the emergency room before the operation. Between 4th and 6th day following operation the patients were screened for deep vein thrombosis: Clinical examination, Liquid Crystal Contact Thermography (LCCT), colour coded ultrasound examination and with phlebography. 33 patients have been treated with standard-heparin and 35 with low-molecular-heparin. In the group of standard-heparin 30% of all the patients showed a deep vein thrombosis, whereas only 17% deep vein thrombosis were found in the group treated with low-molecular-heparin. But to reach statistical significance in both groups 60 patients are needed. Postoperative haemorrhagic complications were seen in 6.1% in the group of standard-heparin and in 8% in the group of low-molecular-heparin. The LCCT and the ultrasound examination were compared with the phlebography. The LCCT had a sensitivity of 92% and a specificity of 85%. The ultrasound examination had a sensitivity of only 15%! Therefore the ultrasound examination is an unsuitable screening method to detect deep vein thrombosis in patients with fractures of the proximal end of the femur.
Platz
A
A
Klinik für Unfallchirurgie, Universitätsspital Zürich.
Hoffmann
R
R
Kohler
A
A
Bischof
T
T
Trentz
O
O
D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013923:Thromboembolism / Q000517:prevention & control*
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
Thromboembolieprophylaxe bei Hüftfraktur: Unfraktioniertes Heparin versus niedermolekulares Heparin (eine prospektive, randomisierte Untersuchung).