Document Detail


Prevention of deep-vein thrombosis after total knee replacement. Randomised comparison between a low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system.
MedLine Citation:
PMID:  10463739     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal regime of antithrombotic prophylaxis for patients undergoing total knee arthroplasty (TKA) has not been established. Many surgeons employ intermittent pneumatic compression while others use low-molecular-weight heparins (LMWH) which were primarily developed for total hip arthroplasty. We compared the efficacy and safety of these two techniques in a randomised study with blinded assessment of the endpoint by phlebography. We randomised 130 patients, scheduled for elective TKA, to receive one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight) or continuous intermittent pneumatic compression of the foot by means of the arteriovenous impulse system. A total of 108 patients (60 in the LMWH group and 48 in the mechanical prophylaxis group) had phlebography eight to 12 days after surgery. Of the 47 with deep-vein thrombosis, 16 had received LMWH (26.7%, 95% CI 16.1 to 39.7) and 31, mechanical prophylaxis (64.6%, 95% CI 49.5 to 77.8). The difference between the two groups was highly significant (p < 0.001). Only one patient in the LMWH group had severe bleeding. We conclude that one daily subcutaneous injection of calcium nadroparin in a fixed, weight-adjusted dosage scheme is superior to intermittent pneumatic compression of the foot for thromboprophylaxis after TKA. The LMWH scheme was also safe.
Authors:
J Blanchard; J Y Meuwly; P F Leyvraz; M J Miron; H Bounameaux; P Hoffmeyer; D Didier; P A Schneider
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  81     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  1999 Jul 
Date Detail:
Created Date:  1999-09-08     Completed Date:  1999-09-08     Revised Date:  2010-11-10    
Medline Journal Info:
Nlm Unique ID:  0375355     Medline TA:  J Bone Joint Surg Br     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  654-9     Citation Subset:  AIM; IM    
Affiliation:
Hôpital Orthopédique de la Suisse Romande, Lausanne, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anticoagulants / therapeutic use*
Arthroplasty, Replacement, Knee*
Female
Humans
Middle Aged
Nadroparin / therapeutic use*
Postoperative Complications / prevention & control*
Venous Thrombosis / prevention & control*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Nadroparin
Comments/Corrections
Comment In:
J Bone Joint Surg Br. 2000 Mar;82(2):304-5   [PMID:  10755445 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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