[Clexane (enoxaprin) or Fragmin (dalteparin) for thrombolytic prevention in hip replacement surgery?]

In an attempt to reduce medical costs it was decided that four Oslo hospitals should use the same low molecular weight heparin (LMWH) for thromboprophylaxis. Clexane was chosen because it was slightly cheaper than Fragmin. Experts in haematology stated that a daily dose of 40 mg Clexane was equivalent to 5,000 units of Fragmin in high risk surgery. After changing from Fragmin to Clexane for thromboprophylaxis in connection with total hip replacement, an unacceptable increase in perioperative bleeding complications was experienced. Thus, after being used in 18 patients, use of Clexane was discontinued. We compared the group given Clexane with the last 18 total hip replacement patients who had received Fragmin. The two groups were comparable with regard to base line characteristics. In both groups the thromboprophylaxis was started the evening before the operation. We found a statistically significant increase in postoperative wound and drain-site discharge and in number of days with elevated body temperature in the Clexane group. Even though the Clexane group received an average of 1.5 blood units more, their haemoglobin value at discharge from the department was significantly lower. We conclude that a daily dose of Clexane led to more bleeding than 5,000 units of Fragmin did.