Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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PREVENTION OF DEEP-VEIN THROMBOSIS BY LOW-DOSE HEPARIN IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENT

The Lancet ◽

10.1016/s0140-6736(74)91069-1 ◽

1974 ◽

Vol 304 (7884) ◽

pp. 797-800 ◽

Cited By ~ 42

Author(s):

G.K. Morris ◽

A.P.J. Henry ◽

B.J. Preston

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

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EFFICACY OF LOW-DOSE HEPARIN IN PREVENTION OF EXTENSIVE DEEP-VEIN THROMBOSIS IN PATIENTS UNDERGOING TOTAL-HIP REPLACEMENT

The Lancet ◽

10.1016/s0140-6736(76)91541-5 ◽

1976 ◽

Vol 307 (7970) ◽

pp. 1151-1154 ◽

Cited By ~ 104

Author(s):

S. Sagar ◽

J.D. Stamatakis ◽

A.F. Higgins ◽

D. Nairn ◽

F.H. Maffei ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

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The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646293 ◽

1992 ◽

Vol 68 (04) ◽

pp. 436-441 ◽

Cited By ~ 23

Author(s):

Nigel E Sharrock ◽

George Go ◽

Robert Mineo ◽

Peter C Harpel

Keyword(s):

Heart Rate ◽

Deep Vein Thrombosis ◽

Cardiac Index ◽

Total Hip Replacement ◽

Epidural Anesthesia ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

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FAILURE OF LOW-DOSE HEPARIN TO PREVENT DEEP-VEIN THROMBOSIS AFTER HIP-REPLACEMENT ARTHROPLASTY

The Lancet ◽

10.1016/s0140-6736(74)91068-x ◽

1974 ◽

Vol 304 (7884) ◽

pp. 795-797 ◽

Cited By ~ 91

Author(s):

W.G.J. Hampson ◽

H.Keith Lucas ◽

F.C. Harris ◽

P.H. Roberts ◽

I.W. Mccall ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Hip Replacement ◽

Low Dose ◽

Hip Replacement Arthroplasty ◽

Vein Thrombosis ◽

Dose Heparin ◽

Replacement Arthroplasty ◽

Deep Vein ◽

Low Dose Heparin

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Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients

Journal of Neurosurgery ◽

10.3171/jns.1978.49.3.0378 ◽

1978 ◽

Vol 49 (3) ◽

pp. 378-381 ◽

Cited By ~ 160

Author(s):

Dario Cerrato ◽

Cesare Ariano ◽

Folco Fiacchino

Keyword(s):

Deep Vein Thrombosis ◽

Low Dose ◽

Motor Deficit ◽

Control Group ◽

Heparin Group ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin ◽

Heparin Prophylaxis

✓ By the use of 125I-labeled fibrinogen test, the incidence of postoperative deep vein thrombosis (DVT) and the effectiveness of prophylactic low-dose heparin treatment were investigated in 110 patients who underwent elective neurosurgical procedures. Fifty patients were appointed randomly to a control group and 50 to a heparin group (10 patients were excluded since they had DVT before surgery). The incidence of DVT was reduced from 34% in the control group to 6% in the heparin group (p < 0.005). No statistically significant differences were observed in transfusion requirements, postoperative hemoglobin concentration, and the occurrence of postoperative hematomas between the two groups. Positive correlation was observed between DVT and motor deficit (p < 0.05). Preoperative assessment of patients' sensitivity to the standard 5000-unit dose of heparin was performed in all treated patients and is thought an important factor in improving the safety of heparin prophylaxis.

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