Document Detail

Prophylaxis of deep-vein thrombosis in fractures below the knee: a prospective randomised controlled trial.
MedLine Citation:
PMID:  19258618     Owner:  NLM     Status:  MEDLINE    
The incidence of deep-vein thrombosis and the need for thromboprophylaxis following isolated trauma below the knee is uncertain. We have investigated this with a prospective randomised double-blind controlled trial using low molecular weight heparin with saline injection as placebo in patients aged between 18 and 75 years who had sustained an isolated fracture below the knee which required operative fixation. All patients had surgery within 48 hours of injury and were randomised to receive either the placebo or low molecular weight heparin for 14 days, after which they underwent bilateral lower limb venography, interpreted by three independent radiologists. Further follow-up was undertaken at two, six, eight and 12 weeks. A total of 238 patients fulfilled all the inclusion criteria, with 127 in the low molecular weight heparin group and 111 in the placebo group, all of whom underwent bilateral venography. There was no statistically significant difference in the incidence of deep-vein thrombosis between those patients treated with low molecular weight heparin or the placebo (p = 0.22). The number of deep-vein thromboses in the two groups was 11 (8.7%) and 14 (12.6%), respectively. Age and the type of fracture were significantly associated with the rate of deep-vein thrombosis (p = 0.001 and p = 0.009, respectively) but gender, comorbidities and the body mass index were not. The overall incidence of deep-vein thrombosis in this series was 11%. There was no clinical or statistical significant reduction in the incidence of deep-vein thrombosis with the use of thromboprophylaxis. However, we accept that owing to a cessation of funding, recruitment to this trial had to be ended prior to establishing the necessary sample size. Our results cannot, therefore, categorically exclude the possibility that low molecular weight heparin treatment could be beneficial. We recommend a further multicentre trial be undertaken to resolve this matter.
D P Goel; R Buckley; G deVries; G Abelseth; A Ni; R Gray
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  91     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-04     Completed Date:  2009-03-27     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:  388-94     Citation Subset:  AIM; IM    
Department of Orthopaedics, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
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MeSH Terms
Ankle Injuries / surgery
Anticoagulants / therapeutic use*
Dalteparin / therapeutic use*
Double-Blind Method
Fractures, Bone / surgery*
Leg Injuries / surgery*
Middle Aged
Postoperative Care / methods
Postoperative Complications / prevention & control,  radiography
Tibial Fractures / surgery
Venous Thrombosis / prevention & control*,  radiography
Young Adult
Reg. No./Substance:
0/Anticoagulants; 0/Dalteparin

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

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