Prevention of Deep Vein Thrombosis After Hip Replacement: Randomised Comparison Between Unfractionated Heparin and Low Molecular Weight Heparin

Overview

Journal BMJ

Specialty General Medicine

Date 1991 Sep 7

PMID 1655136

Citations 35

Authors

P F Leyvraz

F Bachmann

J Hoek

H R Buller

M Postel

M Samama

M D Vandenbroek

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

RANDOMIZED CLINICAL TRIAL OF ASPIRIN AS PROPHYLAXIS FOR THROMBOEMBOLISM IN HIP ARTHROPLASTY.

Lins R, Rolim E, Lima Y, Moura R Acta Ortop Bras. 2024; 32(1):e272229.

PMID: 38532864 PMC: 10962067. DOI: 10.1590/1413-785220243201e272229.

Thromboprophylaxis across orthopaedic surgery: Bibliometric analysis of the most cited articles.

Sedani A, Yakkanti R, Allegra P, Mattingly L, Aiyer A J Clin Orthop Trauma. 2021; 16:157-167.

PMID: 33717952 PMC: 7920107. DOI: 10.1016/j.jcot.2020.12.015.

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY.

Lins R, Rolim Filho E, Oliveira F, Santos S, Rolim T, Kreimer F Acta Ortop Bras. 2018; 26(2):86-90.

PMID: 29844732 PMC: 5962286. DOI: 10.1590/1413-785220182602187265.

Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients.

Junqueira D, Zorzela L, Perini E Cochrane Database Syst Rev. 2017; 4:CD007557.

PMID: 28431186 PMC: 6478064. DOI: 10.1002/14651858.CD007557.pub3.

The Anti-Factor Xa Range For Low Molecular Weight Heparin Thromboprophylaxis.

Wei M, Ward S Hematol Rep. 2016; 7(4):5844.

PMID: 26733269 PMC: 4691677. DOI: 10.4081/hr.2015.5844.

References

Planes A, Vochelle N, Fagola M, FERET J, Bellaud M . Prevention of deep vein thrombosis after total hip replacement. The effect of low-molecular-weight heparin with spinal and general anaesthesia. J Bone Joint Surg Br. 1991; 73(3):418-22. DOI: 10.1302/0301-620X.73B3.1670442. View

Torholm C, Broeng L, Jorgensen P, Bjerregaard P, Josephsen L, Jorgensen P . Thromboprophylaxis by low-molecular-weight heparin in elective hip surgery. A placebo controlled study. J Bone Joint Surg Br. 1991; 73(3):434-8. DOI: 10.1302/0301-620X.73B3.1670445. View

Verstraete M . Pharmacotherapeutic aspects of unfractionated and low molecular weight heparins. Drugs. 1990; 40(4):498-530. DOI: 10.2165/00003495-199040040-00003. View

Planes A, Vochelle N, MAZAS F, MANSAT C, ZUCMAN J, Landais A . Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost. 1988; 60(3):407-10. View

Barrowcliffe T, Curtis A, Johnson E, Thomas D . An international standard for low molecular weight heparin. Thromb Haemost. 1988; 60(1):1-7. View

Aiach M, Sie P . [Biological monitoring of treatment with low molecular weight heparin]. Ann Biol Clin (Paris). 1988; 46(9):715-8. View

Harris W, Athanasoulis C, Waltman A, Salzman E . Prophylaxis of deep-vein thrombosis after total hip replacement. Dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily. J Bone Joint Surg Am. 1985; 67(1):57-62. View

Dechavanne M, Ville D, Berruyer M, Trepo F, Dalery F, Clermont N . Randomized trial of a low-molecular-weight heparin (Kabi 2165) versus adjusted-dose subcutaneous standard heparin in the prophylaxis of deep-vein thrombosis after elective hip surgery. Haemostasis. 1989; 19(1):5-12. DOI: 10.1159/000215882. View

Collins R, Scrimgeour A, Yusuf S, Peto R . Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med. 1988; 318(18):1162-73. DOI: 10.1056/NEJM198805053181805. View

10.

BEISAW N, Comerota A, Groth H, Merli G, Weitz H, Zimmerman R . Dihydroergotamine/heparin in the prevention of deep-vein thrombosis after total hip replacement. A controlled, prospective, randomized multicenter trial. J Bone Joint Surg Am. 1988; 70(1):2-10. View

11.

Leyvraz P, Bachmann F, Vuilleumier B, Berthet S, Bohnet J, Haller E . Adjusted subcutaneous heparin versus heparin plus dihydroergotamine in prevention of deep vein thrombosis after total hip arthroplasty. J Arthroplasty. 1988; 3(1):81-6. DOI: 10.1016/s0883-5403(88)80056-1. View

12.

Dorfman G, Cronan J, Tupper T, Messersmith R, Denny D, Lee C . Occult pulmonary embolism: a common occurrence in deep venous thrombosis. AJR Am J Roentgenol. 1987; 148(2):263-6. DOI: 10.2214/ajr.148.2.263. View

13.

Turpie A, Levine M, Hirsh J, Carter C, Jay R, Powers P . A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986; 315(15):925-9. DOI: 10.1056/NEJM198610093151503. View

14.

Merli G, Martinez J . Prophylaxis for deep vein thrombosis and pulmonary embolism in the surgical patient. Med Clin North Am. 1987; 71(3):377-97. DOI: 10.1016/s0025-7125(16)30847-1. View

15.

Paiement G, Wessinger S, Harris W . Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery. Clin Orthop Relat Res. 1987; (223):188-93. View

16.

Salzman E . Low-molecular-weight heparin: is small beautiful?. N Engl J Med. 1986; 315(15):957-9. DOI: 10.1056/NEJM198610093151509. View

17.

Simon P, Kindermans A, Kempf J, Postel M . [Efficacy and tolerance of low molecular weight heparin in the prevention of deep venous thrombosis during non-emergent total hip arthroplasty. A prospective, multicenter trial]. J Chir (Paris). 1990; 127(5):252-7. View

18.

Contant G, Martinoli J . Heparin inactivation during blood storage: its prevention by blood collection in citric acid, theophylline, adenosine, dipyridamole-C.T.A.D. mixture. Thromb Res. 1983; 31(2):365-74. DOI: 10.1016/0049-3848(83)90337-7. View

19.

van den Berg E, Rumpf K, Frohlich H, Walterbusch G, Muller-Vahl H, Reilmann H . Vascular spasm during thromboembolism prophylaxis with heparin-dihydroergotamine. Lancet. 1982; 2(8292):268-9. DOI: 10.1016/s0140-6736(82)90346-4. View

20.

de la Caffiniere J, Mignot M, Bruch J . [The dangerous blood clot in orthopaedic surgery (author's transl)]. Rev Chir Orthop Reparatrice Appar Mot. 1981; 67(1):47-58. View