Prophylaxis Against Postoperative Thromboembolic Complications. A Comparison Between Dextran 70, Dihydroergotamin Heparin and a Sulphated Polysaccarid

1979 ◽  
Author(s):  
D. Bergqvist ◽  
T. Hallböök ◽  
B. Lindblad
Keyword(s):  
Elective Surgery ◽  
Hip Surgery ◽  
Perfusion Scintigraphy ◽  
X Ray ◽  
Vein Thrombosis ◽  
Dextran 70 ◽  
Postoperative Thrombosis ◽  
Fibrinogen Test ◽  
Deep Vein ◽  
Low Dose Heparin

Dextran 70, a fixed combination of dihydroergotamine and low dose heparin (DHEH) and a sulphated polysaccarid (PZ68B) have been compared for prevention of postoperative thromboembolism. The trial has been prospective with separate randomization of patients undergoing elective general surgery, elective hip surgery and hip frecture surgery. Deep vein thrombosis has teen diagnosed with the 125 I-fibrinogen test. In patients undergoing elective hip surgery pulmonary x-ray and perfusion scintigraphy have been made preoperatively and on postoperative day 7, The patients have been followed for 30 days to detect late fatal pulmonary emboli. 253 patients have been studied -(34 exclusions), the main results being as follows:In conclusion there is a good and equal prophylactic effect against postoperative thrombosis of DHEH and PZ68E in elective surgery, and the two methods are as effective as dextran 70 in hip fracture patients.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Randomized study of adjusted versus fixed low dose heparin prophylaxis of deep vein thrombosis in hip surgery

1989 ◽  
Vol 76 (9) ◽  
pp. 933-935 ◽  
Author(s):  
D. A. Taberner ◽  
L. Poller ◽  
J. M. Thomson ◽  
G. Lemon ◽  
F. J. Weighill
Keyword(s):  
Deep Vein Thrombosis ◽  
Low Dose ◽  
Randomized Study ◽  
Hip Surgery ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin ◽  
Heparin Prophylaxis

XaI (Antithrombin III) Activity in Relation to Postoperative Deep Vein Thrombosis (DVT)

1979 ◽  
Author(s):  
I. Wallenbeck ◽  
D. Bergqvist ◽  
T. Hallböök ◽  
E.T. Yin
Keyword(s):  
Low Dose ◽  
Antithrombin Iii ◽  
Elective Surgery ◽  
Specific Test ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Comprehensive Test ◽  
Deep Vein ◽  
Antithrombin Iii Activity ◽  
Low Dose Heparin

65 patients (21 controls, 20 low-dose heparin, 24 dextran) undergoing hip or elective general surgery were tested for Xal activity with a Differential Xal Assay. The test uses activated F X as substrate for determining the biological activity of Xal in two test systems. 1) Comprehensive test measures the ability of undiluted plasma to neutralize Xa in presence of circulating accelerators or antagonists of Xal. 2) Specific test quantitates total Xal activity in a highly diluted plasma system. For screening of DVT, 125-fibrinogen and/or thermography was used. Classification into minor and major DVT was made. Mean preoperative Xal was 8-10% lower in patients who developed postoperative DVT (both tests). Hip fracture patients had significantly lower initial values than patients undergoing elective surgery (comprehensive test). Postoperatively, Xal activity in patients with minor or no DVT remained constant. In patients with major DVT, Xal activity was significantly lower (20-45% in comprehensive and 15-30% in specific test) on operation and first two postoperative days and then returned to preoperative levels. Patients who developed OVT showed the same pattern of Xal despite prophylaxis. Of 14 major DVT, 10 were diagnosed when Xal activity had normalized. This indicates that a decrease in Xal activityimmediately after trauma, can identify patients disposed to develop major thromboembolic complications.

scholarly journals Prophylaxis of Thromboembolic Complications in HIP Surgery - A Controlled Trial with low Dose Heparin and Dextran 70

1977 ◽  
Author(s):  
D. Bergqvist ◽  
H.O. Efsing ◽  
T. Hallböök ◽  
T. Hedlund
Keyword(s):  
Pulmonary Embolism ◽  
Hip Fracture ◽  
Low Dose ◽  
Controlled Trial ◽  
Hip Surgery ◽  
Control Group ◽  
X Ray ◽  
Dose Heparin ◽  
Dextran 70 ◽  
Low Dose Heparin

The prophylactic effect of low dose heparin on postoperative thrombosis in general surgery is well established. Dextran 70 has been shown to reduce the frequency of fatal pulmonary embolism. The effect of these prophylactic methods in-hip surgery is debated. The aim of this study was to compare dextran 70, low dose heparin and no treatment in post-traumatic and elective hip surgery. The groups were separately randomized to either prophylaxis. In patients with hip fracture (75 patients) thrombosis was diagnosed with 125I-fibrinogen test. The same diagnostic method was used after elective hip arthroplasty according to Brunswik (96 patients). In the latter group screening for pulmonary embolism was made one week postoperatively with perfusion scintigraphy (Tc-labelled macroaggregated albumin) and x-ray; the diagnosis being based on the combination of a perfusion defect and normal x-ray. The frequency of thrombosis in patients with hip fracture was 67% in the control group, 67% in the low dose heparin group and 40% in the dextran 70 group. The corresponding frequencies for patients undergoing elective hip surgery were 50, 26 and 55%. Pulmonary embolism was seen in 38, 24 and 24% respectively (one fatal embolism in the control group). From this study it can be concluded that only dextran 70 lowers the frequency of thrombosis after hip fracture. Low dose heparin diminishes the frequency of thrombosis in elective hip surgery whereas the two prophylactic methods are equally effective in prophylaxis of pulmonary embolism.

Hepar Inconcentration, Antithrombin III and Antiplasmin in Elective Surgery with Low Dose Heparin Prophylaxis

1979 ◽  
Author(s):  
H.O. Kruse-Blinkenberg ◽  
Johs Gormsen
Keyword(s):  
Low Dose ◽  
Antithrombin Iii ◽  
Elective Surgery ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
At Iii ◽  
Uptake Test ◽  
Deep Vein ◽  
Low Dose Heparin ◽  
Heparin Prophylaxis

Eighty patients underwent abdominal surgery in low dose heparin (Novo) 5.000 units subcutanously 2 hours preoperatively and every 8 hours until full mobilization. Clinical end points were 125J fibrinogen uptake test and venography. Heparin concentrations, antithrombin III(AT III) against IIa and Xa and antiplasmin, were measured on synthetic substrates (Kabi Diagnostica, Sweden). Deep vein thrombosis (DVT) developed in 16 patients. Heparin concentrations were identical in patients ± DVT preoperatively but the concentrations were significantly lower postoperatively on day 1-5 in the patients with DVT, AT III (against IIa)was lower pre- and postoperatively in patients with DVT, but the differences were only significant lower when measuring AT III against Xa, pre- and postoperatively. The antiplasmin level was higher in patients with malignency and in patients with DVT, and the differences were significant postoperatively (p < 0.01).

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

1976 ◽  
Vol 36 (01) ◽  
pp. 157-164 ◽  
Author(s):  
P. M Mannucci ◽  
Luisa E. Citterio ◽  
N Panajotopoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Dose ◽  
Control Group ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin

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).

The incidence of deep vein thrombosis in Hong Kong Chinese after hip surgery for fracture of the proximal femur

1979 ◽  
Vol 66 (9) ◽  
pp. 640-642 ◽  
Author(s):  
C. K. Mok ◽  
F. T. Hoaglund ◽  
S. M. Rogoff ◽  
S. P. Chow ◽  
A. Ma ◽  
...  
Keyword(s):  
Hong Kong ◽  
Deep Vein Thrombosis ◽  
Proximal Femur ◽  
Hip Surgery ◽  
Hong Kong Chinese ◽  
Vein Thrombosis ◽  
Deep Vein

Dextran and postoperative thromboembolism

1975 ◽  
Vol 13 (11) ◽  
pp. 41-43
Keyword(s):  
Platelet Aggregation ◽  
Coagulation Factors ◽  
Venous Thromboembolic Disease ◽  
Vein Thrombosis ◽  
Dextran 70 ◽  
Lower Blood ◽  
Venous Thromboembolic ◽  
Reduce Platelet Aggregation ◽  
Increase Platelet Aggregation ◽  
Deep Vein

Two preparations of dextran have been tried for prevention of venous thromboembolic disease, dextran-40 (average m. w. 40,000) and dextran-70 (average m.w. 70,000). Dextrans reduce platelet aggregation and lower blood viscosity.1 Dextran may also reduce the peri-operative rise in the coagulation factors V and VIII.2 However, in some tests dextrans increase platelet aggregation3 and accelerate fibrin formation,4 so that only clinical trial can show whether dextran reduces the incidence of either deep-vein thrombosis or of pulmonary embolism.

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