Sustained prothrombotic profile after hip replacement surgery: the influence of prolonged prophylaxis with dalteparin.
In a randomized trial on the effect of dalteparin for 5 weeks after HRS we evaluated hemostatic variables in plasma sampled before and 1, 6 and 35 days postoperatively. In 218 patients we found that prothrombin fragment 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT), d-dimer and fibrinogen were significantly higher on day 35 as compared with baseline values in the placebo group (P < 0.001 for all). The same pattern was found in the dalteparin group, but with significantly lower values for F1 + 2, TAT and d-dimer. In patients in the placebo group with venographically proven deep vein thrombosis (DVT) on day 35 (33%), significantly higher values were found for F1 + 2, TAT and d-dimer than in patients without DVT. Patients in the highest quartile of d-dimer (>2850 ng mL-1) had an odds ratio for the presence of DVT of 24.0 when compared with patients in the lowest quartile (<1625 ng mL-1). It is concluded that a substantial hypercoagulability is sustained until day 35 after HRS, significantly reduced with prolonged administration of dalteparin.
Arnesen
H
H
Center for Clinical Research, Department of Orthopedic Surgery, Ullevål University Hospital, Oslo, Norway. harald.arnesen@ulleval.no
Dahl
O E
OE
Aspelin
T
T
Seljeflot
I
I
Kierulf
P
P
Lyberg
T
T
D000368:Aged; D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001779:Blood Coagulation Factors / Q000032:analysis / Q000187:drug effects; D017985:Dalteparin / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010690:Phlebography; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000517:prevention & control
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D017985:Dalteparin