[Heparin-induced thrombocytopenia as a complication of postoperative prevention of thromboembolism with unfractionated heparin/low molecular weight heparin after hip and knee prosthesis implantation].
OBJECTIVE
With this prospective study we analysed the occurrence of a heparin-induced thrombocytopenia type II (hit type II) using unfractioned heparin (UFH) or low-molecular-weight heparin (LMWH) as postoperative thrombosis prophylaxis after primary total hip or knee replacements. Furthermore the postoperative course of the platelet count with UFH and LMWH was investigated.


METHODS
In a prospective study we looked at the platelet count of 504 primary endoprothesis patients until the 9. postoperative day. 252 patients got UFH (3-mal 5000 IE Liquemin), 252 patients got LMWH (Clexane 40 opd) as thrombosis prophylaxis.


RESULTS
5 patients of the UFH-group developed a HIT type II (incidence 2%; 95%-confidence interval 0.7-4.5) after 9.8 (7-16) days. Within the LMWH-group we saw just one case (incidence 0.4%; 95%-confidence interval 0-2.1). The drop of the platelet count was on average 64% (40.9-81.6). Within the 498 patients without a HIT type II just 2 patients had a drop of the platelet count between the 5. and 9. postoperative day of more than 15% referring to the preoperative value (24% and 33%).


CONCLUSIONS
The incidence of a HIT type II after the use LMWH seems to be lesser than after the use of UFH. The postoperative platelet count shows a typical course after a total joint replacement. With deviations of that a HIT type II must be excluded.
Mahlfeld
K
K
Otto-von-Guericke-Universität Magdeburg, Orthopädische Universitätsklinik, Magdeburg.
Franke
J
J
Schaeper
O
O
Kayser
R
R
Grasshoff
H
H
D000368:Aged; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000517:prevention & control*; D012306:Risk; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced*; D020246:Venous Thrombosis / Q000097:blood / Q000517:prevention & control*
D006495:Heparin, Low-Molecular-Weight; D006493:Heparin
Heparininduzierte Thrombozytopenie als Komplikation der postoperativen Thromboseprophylaxe mit UFH/NMH-Heparinen nach Hüft- und Knieendoprothetik.