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[Thrombosis prophylaxis in orthopedic surgery].

V Finsen1

  • 1Ortopedisk avdeling Regionsykehuset i Trondheim.

Tidsskrift for Den Norske Laegeforening : Tidsskrift for Praktisk Medicin, Ny Raekke
|June 2, 2000
PubMed
Summary

Switching from dextran 70 to low molecular weight heparin significantly reduced thromboembolism after orthopedic surgery. Prolonging prophylaxis beyond two weeks is not recommended due to low complication rates.

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Area of Science:

  • Orthopedic Surgery
  • Thromboembolism Prophylaxis
  • Pharmacological Interventions

Background:

  • Trondheim University Hospital transitioned from dextran 70 to low molecular weight heparin for thromboembolism prophylaxis post-orthopedic surgery in 1992.
  • The study aimed to evaluate the impact of this change on complication rates and assess the need for extended prophylaxis.

Purpose of the Study:

  • To determine if low molecular weight heparin is more effective than dextran 70 in preventing thromboembolic complications.
  • To investigate the incidence of thromboembolic events between postoperative weeks three and six.
  • To evaluate the cost-effectiveness of extending thromboembolism prophylaxis.

Main Methods:

  • Retrospective analysis of patient records before and after the change in prophylaxis.
  • Comparison of thromboembolic complication rates between dextran 70 and low molecular weight heparin groups.
  • Detailed analysis of complications occurring between postoperative weeks three and six.

Main Results:

  • A significant reduction in thromboembolism was observed after implementing low molecular weight heparin (0.54%) compared to dextran 70 (0.76%).
  • Further investigation identified a 0.66% overall complication rate with low molecular weight heparin, with higher rates in total hip arthroplasty (2.2%) and hip fracture (1.5%) patients.
  • Thromboembolic complications in the third to sixth postoperative weeks were infrequent (0.71%) with minimal mortality.

Conclusions:

  • Low molecular weight heparin is more effective in preventing thromboembolism than dextran 70 after orthopedic surgery.
  • Extending thromboembolism prophylaxis beyond two weeks is not justified due to low complication rates and associated costs.
  • Current prophylaxis protocols appear adequate for managing thromboembolic risk in the extended postoperative period.

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