Summary
Since 1973 a prospective trial of anti-thrombotic agents for the prophylaxis of deep venous thrombosis and pulmonary embolism was undertaken in 386 high risk patients. Five drugs were employed:
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1.
A combination of aspirin and dipyridamol (95 patients);
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2.
Dextran 60 (43 patients);
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3.
Dihydroergotamine (61 patients);
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4.
Low dose heparin (63 patients);
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5.
A combination of dihydroergotamine and low dose heparin (twice daily in 61 patients and three times daily in 63 patients).
The patients were investigated by I125 fibrinogen uptake test, phlebography, lung scan and careful clinical evaluation before and after operation. In cases of established thrombosis simultaneous anticoagulation with heparin and coumadin was started. In the first group, 32 (34%) thromboses and three pulmonary emboli were detected of which one patient died. In the dextran group, 24 patients (54%) developed thrombosis and there were no fatal pulmonary emboli. In the low dose heparin group we detected 29 (46%) thromboses and three pulmonary emboli. Only the combination of low dose heparin and dihydroergotamine significantly reduced the incidence of thromboembolic complications — 15 (25%) thromboses and no pulmonary emboli. The application of this combination three times a day showed no further improvement but more haemorrhagic complications appeared.
Since 1975 no fatal pulmonary emboli have occurred in 720 patients undergoing total hip replacement.
Résumé
Depuis 1973, une étude prospective des agents anti-thrombotiques a été entreprise sur 386 malades à haut risque, pour le traitement prophylactique des thromboses veineuses profondes et des embolies pulmonaires. Cinq traitements ont été utilisés:
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1.
L'association d'aspirine et de dipyridamole (95 malades);
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2.
Le dextran 60 (43 malades);
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3.
La dihydroergotamine (61 malades);
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4.
L'héparine à faibles doses (63 malades);
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5.
L'association de dihydroergotamine et d'héparine à faibles doses (deux fois par jour chez 61 malades et trois fois par jour chez 63 malades).
Les malades ont subi les bilans suivants: le test d'assimilation du fibrinogène I125, la phlébographie, la scintigraphie pulmonaire, ainsi qu'une évaluation clinique soigneuse avant et après chaque bilan. En cas de thrombose établie, on a pratiqué une anticoagulation simultanée par l'héparine et la coumadine. Dans le premier groupe, 32 thromboses (34%) et trois embolies pulmonaires ont été observées, avec un mort. Dans le groupe traité au dextran, 24 malades (54%) ont développé une thrombose, mais il n'y a pas eu d'embolie mortelle. Dans le groupe traité par l'héparine à faibles doses, on a noté 29 thromboses (46%) et trois embolies pulmonaires. Le taux d'incidents thromboemboliques n'est réduit significativement que par l'association héparine à faibles doses et dihydroergotamine: 15 thromboses (25%) et aucune embolie pulmonaire. L'utilisation de cette association trois fois par jour n'entraîne pas d'amélioration, mais fait apparaître des complications hémorragiques.
Depuis 1975, il n'est survenu aucune embolie pulmonaire sur une série de 720 malades ayant subi une arthroplastie totale de hanche.
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References
Bergqvist, E., Bergqvist, D., Bronge, A., Dahlgren, S., Lindqvist, B.: An evaluation of early thrombosis prophylaxis following fracture of the femoral neck. A comparison between dextran and dicoumarol. Acta Chir. Scand. 138, 689 (1972)
Bronge, A., Dahlgren, S., Lindqvist, B.: Prophylaxis against thrombosis in femoral neck fractures. A comparison between dextran 70 and dicoumarol. Acta Chir. Scand. 137, 29 (1971)
Daniel, W. J., Moore, A. R., Flanc, C.: Prophylaxis of deep vein thrombosis with dextran 70 in patients with a fractured neck of the femur. Aust. N. Z. J. Surg. 41, 289 (1972)
Doran, S. A. F., White, M., Drury, M.: A clinical trial designed to test the relative value of two simple methods of reducing the risk of venous stasis in the lower limbs during surgical operation, the danger of thrombosis, and a subsequent pulmonary embolus, with a survey of the problem. Br. J. Surg. 57, 20 (1970)
Gruber, U. F., Sturm, V., Rem, J., Schaub, N., Rittmann, W. W.: The present state of prevention of postoperative thromboembolic complications. Bibl. Haematol. (Basel) 41, 98 (1975)
Hampson, W. G. J., Harris, F. C., Keith Lucas, H., Roberts, P. H.: Failure of low-dose-heparin to prevent deep vein thrombosis after hip-replacement arthroplasty. Lancet II, 795 (1973)
Harris, W. H., Salzmann, E. W., Athanasoulis, C., Waltmann, A. G., Baum, S., De Sanctis, R. W.: Comparison of warfarin, low-molecular-weight dextran, aspirin and subcutaneous — heparin in prevention of venous thromboembolism following total hip replacement. J. Bone Joint Surg. [Am.] 56, 1552 (1974)
Harris, W. H., Salzmann, E. W., Athanasoulis, C., Waltmann, A., Baum, S., De Sanctis, R., Potsaid, M. S., Sise, H.: Comparison of 125-fibrinogen count scanning with phlebography for detection of venous thrombi after elective hip surgery. N. Engl. J. Med. 29, 665 (1975)
Kakkar, V. V., Stammatakis, J. D., Lawrence, D., Ward, V. P.: Synergistic effect of heparin and dihydroergotamine in the prophylaxis of postoperative deep vein thrombosis. In: Postoperative Thromboembolie-Prophylaxe. Stuttgart, New York: Schattauer 1977
Korvald, E., Storen, E. J., Ongre, A.: Simultaneous use of warfarin sodium and dextran 70 to prevent postoperative venous thrombosis in patients with hip fractures. J. Oslo City Hosp. 23, 25 (1973)
Morrel, M. T., Truelove, S. C., Barr, A.: Pulmonary embolism. Br. Med. J. II, 830 (1963)
Morris, G. K., Henry, A. P. J., Preston, B. J.: Prevention of deep-vein thrombosis by low dose heparin in patients undergoing total hip replacement. Lancet II, 797 (1974)
Myrvold, H. E., Persson, J. E., Svensson, B., Wassensten, S., Vikterlöf, K. J.: Prevention of thromboembolism with dextran 70 and heparin in patients with femoral neck fractures. Acta Chir. Scand. 139, 609 (1973)
Nicolaides, A. N.: Thromboembolism. Lancaster: Medical and Technical Publishing Co. Ltd. 1975
Roberts, V. C., Cotton, L. T.: Failure of low-dose heparin to improve efficacy of preoperative intermittent calf compression in preventing postoperative deep vein thrombosis. Br. Med. J. III, 458 (1975)
Sagar, S., Nairn, D., Stamatakis, J. D., Maffei, F. H., Higgins, A. F., Thomas, D. P., Kakkar, V. V.: Efficacy of low dose heparin in prevention of extensive deep vein thrombosis in patients undergoing total replacement. Lancet I, 1151 (1976)
Schöndorf, Th. H., Weber, U., Lasch, H. G.: Niedrig dosiertes Heparin und Acetylsalicylsäure nach elektiven Operationen am Hüftgelenk. Dtsch. Med. Wochenschr. 102, 1314 (1977)
Schöndorf, Th. H., Hey, D.: Gerinnungsanalytische Untersuchungen zur Thrombogenese bei großen Hüftgelenksoperationen. Inn. Med. 3, 365 (1976)
Soreff, J., Johnsson, H., Diener, L., Göransson, L.: Acetylsalicylic acid in a trial to diminish thromboembolic complication after elective hip surgery. Acta Orthop. Scand. 46, 246 (1975)
Trentz, O., Zech, G., Behrens, S., Barthels, M., Bockslaff, H., Dowidat, H. J., Wuppermann, Th.: Thrombosefrüherkennung mit markiertem Fibrinogen nach alloplastischen Hüftgelenksersatz. Langenbecks Arch. Chir. (Suppl. Chir. Forum) 171 (1974)
Report of the steering committee of a trial sponsored by the medical research council: Effect of aspirin on postoperative venous thrombosis. Lancet II, 441 (1972)
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Department of Traumatology (Head: Prof. Dr. H. Tscherne)
Department of Radiology, Division I, Clinical Radiology (Head: Prof. Dr. H. Stender)
Department of Radiology, Division IV, Nuclearmedicine and Spec. Biophysic (Head: Prof. Dr. H. Hundeshagen)
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Westermann, K., Trentz, O., Pretschner, P. et al. Thromboembolism after hip surgery. International Orthopaedics 4, 253–257 (1981). https://doi.org/10.1007/BF00266066
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DOI: https://doi.org/10.1007/BF00266066