LMW-Heparin Versus Heparin-Dhe in Orthopaedic Surgery

Abstract

The efficiancy and the side effects of a LMW heparin (FRAGMINR, KabiVitrum) and Heparin-DHE (Sandoz) have been compared in a randomized open prospective study of 120 patients (60/60) undergoing elective surgery on the lower limbs (total hip and knee replacement, corrective osteotomies). A radiofibrinogen uptake test (RFUT) was regularly done on all patients. Positive tests were controlled by ascending phlebography. The parameters, clinically obtained, included the intra-and postoperative blood loss, wound closure, and the incidence of haematoma. Hb, Hk, red and white blood cells, thrombocytes, total protein, aPTT, AT III, TT, and anti-Xy-activity were analyzed at the day before operation, the 2nd, 4th, and 6th day after operation.There were three positive RFUT in the group of LMW heparin (5 per cent), and there were six (10 per cent) in the control group. No pulmonary embolism occurred. In no case an operative treatment of deep vein thrombosis was done. There were no statistically significant differences in intra- and postoperative blood loss, and in the laboratory data, except the anti-Xa-activity, which was significantly higher in the LMW heparin group.The comparative study has shown, that a single daily injection of LMW heparin (FRAGMINR) is more effective than the two daily injections of the combination of UF heparin and DHE in order to prevent postoperative thromboembolism

Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

“…The results after hip fractures or total knee replacement using LMWH are more controversial and there is not enough experience to reach valid conclusions. [36][37][38][39]…”

Low Molecular Weight Heparins and Bleeding

“…Seven trials with Kabi 2165 have been published [10][11][12][13][14][15][16] (Table 2). In the studies in which higher doses were administered, that is, 5000 or 7500 anti-Xa U daily, an increased bleeding tendency was observed.…”

Clinical Use of Low Molecular Weight Heparins and Heparinoids

“…There have been a number of level 3 trials reported recently evaluating low molecular weight heparins in patients undergoing general surgery, [20][21][22] oncologic surgery, 23 gynecologic surgery, 24 prostatic surgery, 25 orthopedic surgery, [26][27][28][29][30] and in medical pa tients. 31 In one of these trials a low molecular weight heparin fraction was compared with placebo, 25 and in seven studies a low molecular weight heparin frac tion was compared with standard unfractionated hep arin, 20,21,23,26,31 in two a low molecular weight hepa rin was compared with unfractionated heparin plus dihydroergotamine, 24,28 in one a heparinoid was com pared with placebo, 22 in one trial a heparinoid was compared with warfarin, 30 and in two trials two dif ferent dosages of low molecular weight heparin were compared. 27,29 In all these studies the rates of venous thrombosis varied between 0 and 20%, and no differ ence was detected between low molecular weight hep arin and the comparison group.…”