Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

Abstract

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

Optimal Duration for Prophylaxis of Deep Vein Thrombosis: The New Focus?

“…The frequency of the latter may be as high as 67% of all cases of thrombotic complications as reported in the classical study by Scurr et al (21). Similar rates have been reported in orthopedic surgery (22)(23)(24) such that thromboembolism following hip replacement surgery is the most common cause of rehospitalization (25).…”

“…CRECT, Bailly Village, and *Pharmacia, St. Quentin en Yvelines, France Manuscript received October 9, 1995; accepted January 23,1996.…”

Prolonged Prophylaxis in Postoperative Medicine

“…40 The risk decreases with time, although the risk period seems to be prolonged after hip arthroplasty and kidney transplantation. [41][42][43][44][45][46] Seagrott et al 47 noted that the most common cause of readmission after hip arthroplasty was DVT. In studies on prophylaxis…”

Hemorrhagic Complications of Anticoagulant Therapy

“…Three of the four studies in patients undergoing lower limb surgery detected no difference in perioperative blood loss or transfusion requirements. 26,27,29,33 Only Mannucci and associates 26 reported an increase in frequency of postoperative bleeding and wound hematoma in patients treated with heparin. There were no fatal hemorrhagic episodes due to heparin in any of the studies.…”