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A short course of low-molecular-weight heparin to prevent deep venous thrombosis after elective total hip replacement
S Gallay1, J P Waddell, P Cardella
1Division of Orthopedic Surgery, University of Toronto, St. Michael's Hospital, Ont.
Objective:
To determine the efficacy of a short course of low-molecular-weight heparin (enoxaparin) in the prevention of deep venous thrombosis and pulmonary embolism after elective total hip replacement.
Design:
A prospective cohort study. Follow-up was a minimum of 3 months.
Setting:
An acute-care hospital with a large-volume practice of elective total joint replacement.
Patients:
A prospective group of 150 patients who required primary total hip arthroplasty and a historic control group of 150 patients. All patients were treated with compression stockings, indomethacin and early mobilization. The treatment group received low-molecular-weight heparin, 30 mg every 12 hours for 5 days postoperatively; the control group received no specific anticoagulant therapy.
Interventions:
Total hip replacement. Doppler venography on postoperative day 5 and 2 to 5 days later if required.
Main Outcome Measures:
Presence or absence of deep venous thrombosis. Wound hemorrhage, transfusion rate, number of units of blood transfused and changes in the hemoglobin level.
Results:
The incidence of proximal deep venous thrombosis (popliteal vein to common iliac vein) was 0% in the treatment group versus 4% in the control group. There was no difference in bleeding or number of transfusions required. There was, however, a significant (p = 0.005) drop in hemoglobin level in the treatment group.
Conclusions:
A short course of low-molecular-weight heparin provides effective protection against proximal deep venous thrombosis without significantly increasing the risk to the patient. The treatment is compatible with early patient discharge and the pharmacologic prevention of heterotopic ossification after total joint replacement.