Intraoperative Heparin Thromboembolic Prophylaxis in Primary Total Hip Arthroplasty

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

“…This is a result of advancements in anesthesia, surgical technique, perioperative care and our better understanding of the pathogenesis of thromboembolic disease during and after surgery [11,24,25,56]. The current low incidence of symptomatic and fatal PE raises the question of whether potent anticoagulation is warranted because these agents have potential side effects from bleeding [2,7,20,42,49,58].…”

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

“…Our findings suggest that a significant reduction in the incidence of DVT cannot be obtained by this intervention, and do not support the initiation of a large randomised trial comparing this approach with the use of enoxaparin or other LMWHs alone. Possible explanations for these results, as compared with those reported by Huo et al 8 for total hip replacement, are the greater potential for thrombosis in patients undergoing TKR and the more effective thromboprophylaxis provided by enoxaparin than by aspirin. 1 To establish a reduction of 50% in the incidence of DVT from the 37% recently reported, 5 with an ␣ of 0.05 and a power of 80%, would require 100 patients in each arm of a randomised controlled trial.…”

“…We therefore initiated this uncontrolled pilot study to determine if the incidence could be reduced by the addition of intraoperative heparin to the standard regime of postoperative thromboprophylaxis with LMWH, as has been reported for total hip replacement. 8 The overall incidences of DVT and of proximal DVT were comparable to those in patients having postoperative LMWH thromboprophylaxis alone. [2][3][4][5][6] Although too small to be definite, this pilot study provides little support for the hypothesis that the addition of intraoperative heparin during TKR will give benefits which are clinically significant compared with postoperative thromboprophylaxis with enoxaparin alone.…”

“…The development of DVT may, however, begin during the operation 7 and the initiation of thromboprophylaxis before the procedure, as is practised in Europe, or the addition of intraoperative heparin, may reduce the incidence of the formation of thrombus. In 1992, Huo et al 8 reported a significant reduction in DVT after total hip replacement when intraoperative heparin was added to their standard regime of postoperative prophylaxis with aspirin. We have therefore carried out a small pilot study in patients undergoing TKR to determine whether the use of intraoperative heparin along with postoperative LMWH may have sufficient potential benefit to justify a larger trial.…”

Venous Thromboembolism and Orthopedic Surgery

“…"Multimodal prophylaxis" following hip replacement surgery refers to the use of nonpharmacological interventions such as autologous blood donation and IPC; administration of unfractionated heparin intraoperatively (before femoral preparation) [74]; expeditious surgery; minimization of femoral vein occlusion and blood loss, plus the use of aspirin for pharmacological prophylaxis [75]. Although the "multimodal prophylaxis" approach has not been subjected to a randomized prospective controlled trial, advocates argue that it obviates the need for potent anticoagulants such as warfarin or LMWH [76,77].…”