Low-Dose Heparin Prophylaxis Against Fatal Pulmonary Embolism
Several controlled trials have shown that low-dose heparin is effective in reducing the incidence of deep vein thrombosis without increasing the risk of bleeding. However its effectiveness in preventing fatal pulmonary embolism has yet to be determined and, for this, a multicentre tiral was organised in which 31 centres took part; patients over the age of 40, undergoing only major elective abdominal, thoracic or orthopaedic surgery were included. They were randomly allocated to a control or heparin group and, for each patient entered in the trial, essential information was recorded in a proforma designed for computer analysis. The incidence of fatal pulmonary embolism was determined by autopsy examination. 4,121 patients were admitted to the trial – 2,076 in the control group and 2,045 in the heparin group. 16 patients in the control group died due to acute massive pulmonary embolism confirmed at autopsy, but only 2 in the heparin group. The difference is statistically significant (P < 0.01). There was no evidence of excessive blood loss during or after surgery. These results will be presented in detail. Low-dose heparin prophylaxis can now be recommended as the method of choice for preventing postoperative fatal pulmonary embolism.