title: Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty.
abstract: BACKGROUND
  Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation.
  
  
  METHODS
  The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy.
  
  
  RESULTS
  The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001).
  
  
  CONCLUSIONS
  The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event.
authors.affiliation: Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York City 10003, USA. craigdv@yahoo.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Della Valle
authors.forename: L M
authors.initials: LM
authors.lastname: Jazrawi
authors.forename: J
authors.initials: J
authors.lastname: Idjadi
authors.forename: R N
authors.initials: RN
authors.lastname: Hiebert
authors.forename: S A
authors.initials: SA
authors.lastname: Stuchin
authors.forename: D J
authors.initials: DJ
authors.lastname: Steiger
authors.forename: P E
authors.initials: PE
authors.lastname: Di Cesare
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D013923:Thromboembolism / Q000097:blood / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin