The prevention of postoperative deep venous thrombosis with dextran 70

Abstract

One hundred and six patients undergoing major surgery were given dextran 70‐500 ml. during operation, 500 ml. on the following day, and then 500 ml. on alternate days until discharge. Of these patients, I developed a deep venous thrombosis after the operation (0‐94 per cent). One hundred and one patients acted as control subjects and, of these, 10 developed deep venous thrombosis (9‐9 per cent). This reduction in incidence of thrombosis is significant at the 2 per cent level, indicating that dextran 70, as macrodex 6 per cent in 5 per cent dextrose, in the régime given is a simple and effective means of reducing deep venous thrombosis after major surgery.

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

“…Thirteen trials [100][101][102][103][104][105][106][107][108][109][110][111][112] (1573 patients) assessed dextran as monotherapy, three trials 85,113,114 (420 patients) assessed dextran as adjunctive therapy (with heparin or an oral anticoagulant as background therapy) and two trials 61,115 (252 patients) assessed adding dextran to a mechanical compression method ( Figure 22).…”

Prevention of Venous Thromboembolism

“…In summary, a number of well-designed controlled studies have demonstrated that dextran prophylaxis can prevent venous thrombosis [26,28,42] and pulmonary embolism [105] after elective general surgery as well as venous thrombosis after orthopedic surgery [3,66,100,130], but some other studies have failed to show these effects [16,30,90,166], perhaps because dextran was infused too slowly [16,30,166]. Although the evidence favors the view that dextran is effective in some dosage schedules, it is not an ideal prophylactic agent, because of its potential for serious side effects, its expense, and the need for repeated intravenous infusions.…”

“…The results of 6 prospective, randomized studies which have assessed the effect of dextran prophylaxis on the incidence of postoperative thrombosis detected with 125 I-Fibrinogen leg-scanning are shown in Table 21. Three studies showed a marked and statistically significant reduction of leg-scan detected thrombosis [26,28,42], while 3 others did not [16,105,166]. It is difficult to explain these differences.…”

“…Thus, Bonnar et al [26,28] found that 1 liter of Dextran 70 given in 6 hours during and after surgery (the first 500 ml given in 1 hour) was effective, while Kline et al [105], using a similar dose, found no such effect on the incidence of postoperative venous thrombosis, though they did find a reduced incidence of pulmonary embolism in treated patients (see Table 20). In two other studies which showed no effect of dextran prophylaxis [16,166], a smaller dose (500 ml) was given over 4 hours during surgery, and again on the first day [16] or the first two days [166], after surgery, but Carter and Eban [42] found this dose and infusion rate to be effective. However, they continued to give dextran infusions on alternate days until the patients were discharged from hospital [42].…”

“…In two other studies which showed no effect of dextran prophylaxis [16,166], a smaller dose (500 ml) was given over 4 hours during surgery, and again on the first day [16] or the first two days [166], after surgery, but Carter and Eban [42] found this dose and infusion rate to be effective. However, they continued to give dextran infusions on alternate days until the patients were discharged from hospital [42]. A further leg-scan study in which Dextran 70 was given only postoperatively showed no benefit [183].…”