Intraoperative heparin in addition to postoperative low-molecular-weight heparin for thromboprophylaxis in total knee replacement

Abstract

The administration of heparin during operation has been reported to enhance the efficacy of thromboprophylaxis in patients undergoing total hip replacement. We have performed a small pilot study in which intraoperative doses of heparin were given in addition to the usual postoperative thromboprophylaxis with enoxaparin in 32 patients undergoing total knee replacement. The primary endpoint was deep-vein thrombosis (DVT) as demonstrated by bilateral venography on 6 +/- 2 days after operation. Sixteen patients developed DVT; in two the thrombosis was proximal as well as distal and in one the occurrence was bilateral. There was one major haemorrhage. These results are similar to those obtained with the use of postoperative thromboprophylaxis with enoxaparin alone. They do not provide support for the initiation of a larger randomised trial of this approach to management.

Preoperative or Postoperative Start of Prophylaxis for Venous Thromboembolism With Low-Molecular-Weight Heparin in Elective Hip Surgery?

“…14 Of the 35 potentially eligible studies, another 21 had to be ex-cluded. Of these, 13 were published more than once, [15][16][17][18][19][20][21][22][23][24][25][26][27] 6 studies investigated patients with hip and/or knee arthroplasty where the data could not be analyzed separately, [28][29][30][31][32][33] and 2 studies included patients with hip fractures. 34,35 Thus, a total of 14 trials that reported on 19 cohorts of patients were included.…”

Recommendations from the ICM-VTE: General

“…The exception is for one of the cohorts (adjusted dose heparin) in the study by Huo et al, for which in comparison with a historical control group there was a reduction in VTE (p = 0.37) 494 . Another prospective study in TKA was a single arm cohort without any comparator 498 . A prospective cohort study in patients with lumbar spine surgery compared UFH 50 - 75 units/Kg with control without any difference in VTE or blood loss (after adjustments for confounders) 499 .…”

Bilateral vs. ipsilateral venography as the primary efficacy outcome measure in thromboprophylaxis clinical trials: a systematic review

“…A total of 103 of these articles were excluded from the systematic review because: the results of venography were not reported separately for the legs or were ambiguous with respect to the side of thrombus involvement (70); venography was done outside the prespecified window of 5–14 days (8); or were previously published (25). The remaining 48 studies were included in the systematic review, with 23 studies in elective hip replacement (Table 1) [4–6,10–34], nine studies in hip fracture repair (Table 2) [4,7,35–42], 10 studies in elective knee arthroplasty (Table 3) [3,4,8,15,25,33,43–50], and six studies that included a mix of patients undergoing different procedures [15,25,33,51–53]. Three of these mixed studies provided separate results for patients undergoing hip or knee arthroplasty and they are listed in the respective tables (Tables 1 and 2,[15,25,33]); results from the three remaining studies were not pooled [51–53].…”