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Low-Molecular-Weight Heparin (Enoxaparin) vs Dextran 70: The Prevention of Postoperative Deep Vein Thrombosis After Total Hip Replacement

Low-Molecular-Weight Heparin (Enoxaparin) vs Dextran 70: The Prevention of Postoperative Deep... Abstract A prospective randomized study compared the thromboprophylactic efficacy and safety of a low-molecular-weight heparin (LMWH), enoxaparin (40.6 mg subcutaneously once daily), with a standard regimen of dextran 70 in patients undergoing elective total hip replacement. Deep vein thrombosis was diagnosed by bilateral ascending phlebography 7 to 11 days after operation. Two hundred forty-six patients were included and 219 were eligible for analysis. Deep vein thrombosis was diagnosed in seven of 108 patients in the LMWH group and in 24 of 111 patients in the dextran group. Clinical symptoms of pulmonary embolism did not develop in any patients during the study. In the postoperative period, patients receiving LMWH had a lower blood loss in drains and required fewer blood transfusions than patients receiving dextran, although no significant differences were noted between the groups with respect to the total number of blood transfusions required. Bleeding events and adverse events did not differ between the groups. None of the patients died in hospital during the study. One patient in the LMWH group died at home 15 days after the operation. Three patients receiving dextran had development of symptomatic deep vein thrombosis after hospital discharge. In conclusion, enoxaparin was a more effective thromboprophylactic than a standard regimen of dextran in patients undergoing total hip replacement. The two regimens were equally safe under the clinical conditions. (Arch Intern Med. 1991;151:1621-1624) References 1. Turpie AGG, Levine MN, Hirsh J, et al. A randomized controlled trial of a low-molecular-weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery . N Engl J Med . 1986;315:925-929.Crossref 2. Planes A, Vochelle N, Mazas F, et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement . Thromb Haemost . 1988;60:407-410. 3. Lassen MR, Borris LC, Christiansen HM, et al. Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery . Br J Surg . 1988;75:686-689.Crossref 4. Office of Medical Applications of Research, National Institutes of Health. Prevention of venous thrombosis and pulmonary embolism . JAMA . 1986;256:744-749.Crossref 5. Teien AN, Lie M. Evaluation of amidolytic heparin assay method: increased sensitivity by adding purified antithrombin III . Thromb Res . 1977;10:399-410.Crossref 6. Rabinov K, Paulin S. Roentgendiagnosis of venous thrombosis in the leg . Arch Surg . 1972;104:134-144.Crossref 7. Zachrisson BE, Jansen H. Phlebographic signs in fresh postoperative venous thrombosis of the lower extremity . Acta Radiol . 1973;14:82-96. 8. Kim K, De Mets DL. Design and analysis of group sequential tests based on type I error spending rate function . Biometrika . 1987;74:149-154.Crossref 9. Zelen M. The analysis of several 2 by 2 contingency tables . Biometrika . 1971;58:129-137. 10. Metha C, Patel N, Wei L. Computing exact significance test with restricted randomization rules . Biometrika . 1988;75:295-302.Crossref 11. Eriksson BI, Zachrisson BE, Teger-Nilsson AC, Risberg B. Thrombosis prophylaxis with low molecular weight heparin in total hip replacement . Br J Surg . 1988;75:1053-1057.Crossref 12. Bergqvist D, Burmark US, Frisell J, et al. Low molecular weight heparin once daily compared with conventional low-dose heparin twice daily: a prospective trial on prevention of postoperative thrombosis . Br J Surg . 1986;73:204-208.Crossref 13. Bergqvist D, Mätzsch T, Burmark US, et al. Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis . Br J Surg . 1988;75:888-891.Crossref 14. Levine MN, Planes A, Hirsch J, Goodyear M, Vochelle N, Gent M. The relationship between anti-factor Xa level and clinical outcome in patients receiving enoxaparine low molecular weight heparin to prevent deep vein thrombosis after hip replacement . Thromb Haemost . 1989;62:940-944. 15. Modig J, Borg T, Karlström G, Maripuu E, Sahlstedt B. Thromboembolism after total hip replacement: role of epidural and general anesthesia . Anesth Analg . 1983;62:174-180.Crossref 16. Thorburn J, Louden JR, Vallance R. Spinal and general anaesthesia in total hip replacement: frequency of deep vein thrombosis . Br J Anaesth . 1980;52:1117-1120.Crossref 17. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity . Br J Surg . 1988;75:299-304. 18. Fredin H, Rosberg B. Anaesthetic techniques and thromboembolism in total hip arthroplasty . Eur J Anaesthesiol . 1986;3:273-281. 19. Bergqvist D. Postoperative Thromboembolism . Berlin, Federal Republic of Germany: Springer Verlag; 1983:129-134. 20. Ljungström K-G. Dextran prophylaxis of fatal pulmonary embolism . World J Surg . 1983;7:767-772.Crossref 21. Gruber UF, Salden T, Brokop T, et al. Incidence of fatal pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study . Br Med J . 1980;280:69-72.Crossref 22. Salzman EW, Davies GC. Prophylaxis of venous thromboembolism: analysis of cost-effectiveness . Ann Surg . 1980;191:207-218.Crossref 23. De Angelis J. Hazards of subdural and epidural anaesthesia during anticoagulant therapy: a case report and review . Anesth Analg . 1972;51:676-679. 24. Scurr JH, Coleridge-Smith PD, Hasty JH. Deep venous thrombosis: a continuing problem . BMJ . 1988;297:28.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Low-Molecular-Weight Heparin (Enoxaparin) vs Dextran 70: The Prevention of Postoperative Deep Vein Thrombosis After Total Hip Replacement

Archives of Internal Medicine , Volume 151 (8) – Aug 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400080105020
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Abstract

Abstract A prospective randomized study compared the thromboprophylactic efficacy and safety of a low-molecular-weight heparin (LMWH), enoxaparin (40.6 mg subcutaneously once daily), with a standard regimen of dextran 70 in patients undergoing elective total hip replacement. Deep vein thrombosis was diagnosed by bilateral ascending phlebography 7 to 11 days after operation. Two hundred forty-six patients were included and 219 were eligible for analysis. Deep vein thrombosis was diagnosed in seven of 108 patients in the LMWH group and in 24 of 111 patients in the dextran group. Clinical symptoms of pulmonary embolism did not develop in any patients during the study. In the postoperative period, patients receiving LMWH had a lower blood loss in drains and required fewer blood transfusions than patients receiving dextran, although no significant differences were noted between the groups with respect to the total number of blood transfusions required. Bleeding events and adverse events did not differ between the groups. None of the patients died in hospital during the study. One patient in the LMWH group died at home 15 days after the operation. Three patients receiving dextran had development of symptomatic deep vein thrombosis after hospital discharge. In conclusion, enoxaparin was a more effective thromboprophylactic than a standard regimen of dextran in patients undergoing total hip replacement. The two regimens were equally safe under the clinical conditions. (Arch Intern Med. 1991;151:1621-1624) References 1. Turpie AGG, Levine MN, Hirsh J, et al. A randomized controlled trial of a low-molecular-weight heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery . N Engl J Med . 1986;315:925-929.Crossref 2. Planes A, Vochelle N, Mazas F, et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement . Thromb Haemost . 1988;60:407-410. 3. Lassen MR, Borris LC, Christiansen HM, et al. Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery . Br J Surg . 1988;75:686-689.Crossref 4. Office of Medical Applications of Research, National Institutes of Health. Prevention of venous thrombosis and pulmonary embolism . JAMA . 1986;256:744-749.Crossref 5. Teien AN, Lie M. Evaluation of amidolytic heparin assay method: increased sensitivity by adding purified antithrombin III . Thromb Res . 1977;10:399-410.Crossref 6. Rabinov K, Paulin S. Roentgendiagnosis of venous thrombosis in the leg . Arch Surg . 1972;104:134-144.Crossref 7. Zachrisson BE, Jansen H. Phlebographic signs in fresh postoperative venous thrombosis of the lower extremity . Acta Radiol . 1973;14:82-96. 8. Kim K, De Mets DL. Design and analysis of group sequential tests based on type I error spending rate function . Biometrika . 1987;74:149-154.Crossref 9. Zelen M. The analysis of several 2 by 2 contingency tables . Biometrika . 1971;58:129-137. 10. Metha C, Patel N, Wei L. Computing exact significance test with restricted randomization rules . Biometrika . 1988;75:295-302.Crossref 11. Eriksson BI, Zachrisson BE, Teger-Nilsson AC, Risberg B. Thrombosis prophylaxis with low molecular weight heparin in total hip replacement . Br J Surg . 1988;75:1053-1057.Crossref 12. Bergqvist D, Burmark US, Frisell J, et al. Low molecular weight heparin once daily compared with conventional low-dose heparin twice daily: a prospective trial on prevention of postoperative thrombosis . Br J Surg . 1986;73:204-208.Crossref 13. Bergqvist D, Mätzsch T, Burmark US, et al. Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis . Br J Surg . 1988;75:888-891.Crossref 14. Levine MN, Planes A, Hirsch J, Goodyear M, Vochelle N, Gent M. The relationship between anti-factor Xa level and clinical outcome in patients receiving enoxaparine low molecular weight heparin to prevent deep vein thrombosis after hip replacement . Thromb Haemost . 1989;62:940-944. 15. Modig J, Borg T, Karlström G, Maripuu E, Sahlstedt B. Thromboembolism after total hip replacement: role of epidural and general anesthesia . Anesth Analg . 1983;62:174-180.Crossref 16. Thorburn J, Louden JR, Vallance R. Spinal and general anaesthesia in total hip replacement: frequency of deep vein thrombosis . Br J Anaesth . 1980;52:1117-1120.Crossref 17. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity . Br J Surg . 1988;75:299-304. 18. Fredin H, Rosberg B. Anaesthetic techniques and thromboembolism in total hip arthroplasty . Eur J Anaesthesiol . 1986;3:273-281. 19. Bergqvist D. Postoperative Thromboembolism . Berlin, Federal Republic of Germany: Springer Verlag; 1983:129-134. 20. Ljungström K-G. Dextran prophylaxis of fatal pulmonary embolism . World J Surg . 1983;7:767-772.Crossref 21. Gruber UF, Salden T, Brokop T, et al. Incidence of fatal pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study . Br Med J . 1980;280:69-72.Crossref 22. Salzman EW, Davies GC. Prophylaxis of venous thromboembolism: analysis of cost-effectiveness . Ann Surg . 1980;191:207-218.Crossref 23. De Angelis J. Hazards of subdural and epidural anaesthesia during anticoagulant therapy: a case report and review . Anesth Analg . 1972;51:676-679. 24. Scurr JH, Coleridge-Smith PD, Hasty JH. Deep venous thrombosis: a continuing problem . BMJ . 1988;297:28.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1991

References