Document Detail


Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin.
MedLine Citation:
PMID:  1655136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the efficacy and safety of two subcutaneous prophylactic regimens for postoperative deep vein thrombosis after total hip replacement. DESIGN: Prospective open randomised multicentre trial. SETTING: 28 European departments of orthopaedic surgery. INTERVENTION: All patients had bilateral phlebography 10 days after surgery. 31 patients receiving low molecular weight heparin and 29 receiving unfractionated heparin were excluded from the efficacy analysis for various reasons. PATIENTS: 349 patients undergoing total hip replacement between September 1988 and May 1989. 174 patients received subcutaneously a low molecular weight heparin (Fraxiparine) with anti-factor Xa activity of 41 IU/kg/day for three days, then 62 IU/kg/day from day 4 to day 10. 175 patients received subcutaneous unfractionated heparin at intervals of eight hours; doses were adjusted to maintain the activated thromboplastin time at two to five seconds above control values. MAIN OUTCOME MEASURE: Total incidence of deep vein thrombosis and incidence of proximal deep vein thrombosis on bilateral phlebography. RESULTS: The total incidence of deep vein thrombosis was 16% in patients receiving unfractionated heparin and 12.6% in patients receiving low molecular weight heparin (p = 0.45), and the incidence of thrombosis of the proximal veins was 13.1% and 2.9% respectively (p less than 0.001). Four patients receiving unfractionated heparin and one receiving low molecular weight heparin developed pulmonary embolism. The incidence of bleeding complications was low and comparable in the two groups. CONCLUSION: Low molecular weight heparin is at least as effective as unfractionated heparin in preventing deep vein thrombosis and is more effective at preventing thrombosis of the proximal veins in patients undergoing hip replacement. Low molecular weight heparin is not more likely to cause bleeding complications and is simpler to give than unfractionated heparin.
Authors:
P F Leyvraz; F Bachmann; J Hoek; H R B?ller; M Postel; M Samama; M D Vandenbroek
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  303     ISSN:  0959-8138     ISO Abbreviation:  BMJ     Publication Date:  1991 Sep 
Date Detail:
Created Date:  1991-11-12     Completed Date:  1991-11-12     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  543-8     Citation Subset:  AIM; IM    
Affiliation:
Vaudois University Hospital, Lausanne, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Blood Coagulation / drug effects
Hemorrhage / etiology
Heparin / adverse effects,  therapeutic use*
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use*
Hip Prosthesis*
Humans
Injections, Subcutaneous
Postoperative Complications / prevention & control*
Pulmonary Embolism / etiology
Thrombin Time
Thrombocytopenia / etiology
Thrombophlebitis / etiology,  prevention & control*
Chemical
Reg. No./Substance:
0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin
Comments/Corrections
Comment In:
BMJ. 1991 Dec 14;303(6816):1549   [PMID:  1782506 ]
BMJ. 1991 Nov 9;303(6811):1202-3   [PMID:  1747629 ]
BMJ. 1991 Sep 28;303(6805):784   [PMID:  1657259 ]
BMJ. 1991 Sep 7;303(6802):531-2   [PMID:  1655134 ]
Erratum In:
BMJ 1991 Nov 16;303(6812);1243

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


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