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Published on: June 2, 2015
Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total
1Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Korea.
Insights
Low molecular weight dextran and aspirin effectively reduced deep vein thrombosis (DVT) incidence after hip replacement surgery. Dextran showed a significant reduction, while aspirin also demonstrated a beneficial effect, with both treatments well-tolerated.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Pharmacology
Background:
- Deep vein thrombosis (DVT) is a significant complication following total hip replacement (THR).
- Identifying effective prophylaxis strategies is crucial to reduce DVT incidence and associated risks.
Purpose of the Study:
- To compare the efficacy of low molecular weight dextran and aspirin versus no prophylaxis for DVT prevention in Korean patients undergoing primary uncemented THR.
- To identify risk factors for DVT in this patient population.
Main Methods:
- A randomized controlled trial involving 150 patients undergoing primary uncemented THR.
- Three groups: control (no prophylaxis), aspirin (1.2g daily), and low molecular weight dextran (500ml IV).
- Contrast venography performed pre- and post-surgery to assess DVT incidence and thrombus location.
Main Results:
- DVT incidence was 20% in controls, 12% in the aspirin group (p<0.1), and 6% in the dextran group (p<0.05).
- The ratio of proximal to distal thrombi was higher in the control group compared to treated groups.
- Obesity and long-term steroid use were identified as significant risk factors for DVT in the control group.
Conclusions:
- Low molecular weight dextran significantly reduces DVT incidence after uncemented THR.
- Aspirin also demonstrated a trend towards reducing DVT, though less effective than dextran.
- Understanding surgical positioning's impact on venous blood flow is important for DVT prevention strategies.
Abstract:
150 Korean patients undergoing primary uncemented total hip replacement were randomized into 3 treatment groups for deep vein thrombosis (DVT) prophylaxis. Group A(50) were controls; Group B(50) received aspirin 1.2 g daily in 3 divided doses from 2 days before, to 14 days after surgery; Group C(50), received low molecular weight dextran 500 ml, infused intravenously at 50 ml/hour during surgery, and on each of the following 2 days. Contrast venograms were performed prior to surgery and 7-10 days after. The incidence of DVT was 20% in the control group, 12% in the aspirin group (p < 0.1 vs control), and 6% in the dextran group (p < 0.05 vs control). In patients developing DVT, the ratio of proximal to distal thrombi was increased in the control group as compared to treated groups (4:1 in the control group vs 1.5:1 in the treated groups). Both aspirin and dextran were well tolerated. Obesity (p < 0.05) and long-term administration of steroids (p < 0.05) were risk factors for deep vein thrombosis which reached statistical significance in the control group. Intraoperative venograms performed on 10 patients, showed that hip flexion (mean 40.4 degrees) plus adduction (mean 11.5 degrees) plus internal rotation (mean 81.5 degrees), resulted in severe twisting or kinking of the femoral vein with stagnation of blood flow. Low molecular weight dextran significantly reduce the incidence of deep venous thrombosis and aspirin, though less effective, had a similar effect.
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