New insights into extended prophylaxis after orthopaedic surgery - the North American Fragmin Trial experience.
It is well-known that peri-operative and post-operative venous thrombosis are common. Trials in Europe have shown that extended out-of-hospital prophylaxis with a low-molecular-weight heparin reduces the rate of deep vein thrombosis in patients undergoing elective hip surgery. North American investigators of limited-outcome descriptive studies, however, have suggested that out-of-hospital prophylaxis is not necessary. To resolve this uncertainty, NAFT (North American Fragmin Trial) was conducted, the results of which are summarized in this paper. The findings of NAFT support the favourable findings of the European studies on extended prophylaxis. Furthermore, European data have shown extended out-of-hospital prophylaxis to be cost-effective. On the basis of the aggregate data, it is felt that the A2 recommendation made by the Fifth American College of Chest Physicians consensus conference for extended prophylaxis should be changed to an A1 recommendation.
Thrombosis Research Unit, University of Calgary, Calgary, Alberta, Canada. jeanne.sheldon@crha-health.ab.ca
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D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D003362:Cost-Benefit Analysis; D017985:Dalteparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003657:Decision Making; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D016527:Drug Costs; D017558:Elective Surgical Procedures; D005500:Follow-Up Studies; D006406:Hematoma / Q000139:chemically induced; D006801:Humans; D009656:North America; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011184:Postoperative Period; D017410:Practice Guidelines as Topic; D012449:Safety; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin; D017985:Dalteparin