Attitudes to, and utilization of, low molecular weight heparins in joint replacement surgery

A postal survey was carried out to determine the attitudes to the use of low molecular weight heparin (LMWH) in joint replacement among two representative groups of orthopaedic surgeons practising in the UK. 72% of hip surgeons and 51% of knee surgeons replying had used LMWHs for deep vein thrombosis prophylaxis in joint replacement patients. Of these, 48% had discontinued LMWH use due to bleeding complications. Among those continuing to use LMWHs, 88% had witnessed excessive bruising around the wound and 53% had experienced increased wound bleeding or haematomas. Although LMWHs have been shown to reduce post-operative thromboembolism in these groups, clinical experience has revealed an increased incidence of bleeding complications associated with their use. This has prevented their routine use in joint replacement, as was the case with unfractionated heparin in the past.