Skip to main content
SpringerLink
Log in

Prevention of deep vein thrombosis in patients with hip fractures: Low molecular weight heparin versus dextran

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin®) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%,p<0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.

Résumé

Par un essai thérapeutique ouvert et randomisé, on a comparé l'efficacité antithrombotique de l'héparine à bas poids moléculaire (LMWH: Sandoparin) à celle de Dextran 70 chez des patients opérés d'une fracture du col de fémur. Cent treize patients ont reçu une dose unique de 36 mg de LMWH en sous-cutanée alors que 103 patients ont reçu 1500 ml de Dextran 70 par voie IV en trois injections. L'éventualité d'une thrombose profonde (TP) postopératoire a été évaluée par un algorythme diagnostique utilisantile fibrinogène marqué (à l'iode 125) comme examen de dépistage et l'examen échographie/Doppler ou la phlébographie ascendante pour confirmer le diagnostic. La fréquence de TP a été significativement plus basse chez les patients recevant la LMWH par rapport à ceux qui recevaient le Dextran (15.5% vs 32.6%, respectivement,p<0.005). La TP proximale a été rare dans les deux groupes (2% vs 1%, respectivement). Il n'y a eu qu'un seul cas fatal d'embolie graisseuse pulmonaire, observé dans le groupe recevant le Dextran. Il y a eu trois cas d'embolie pulmonaire plus tardifs: un cas mortel dans le groupe Dextran, 14 jours après l'opération et deux cas (un mortel et un non mortel) dans le groupe LMWH, respectivement 14 et 17 jours après. Il n'y a eu aucune complication hémorragique majeure dans les deux groupes. Nous concluous que la LMWH est sûre, bien tolérée et est plus efficace pour prévenir la TP que la Dextran.

Resumen

Se emprendió un ensayo clínico randomizado con el propósito de comparar la eficacia antitrombótica de una heparina de bajo peso molecular (HBPM; Sandoparina) con la del dextrán 70 en pacientes sometidos a cirugía por fractura de cadera. 113 pacientes recibieron HBPM una vez al día por vía subcutánea a una dosis fija, y 103 pacientes recibieron dextrán 70 por vía intravenosa. La presencia de trombosis venosa profunda postoperatoria (TVP) fue determinada mediante un algorritmo utilizando la capacitación fibrinogeno125I como prueba de tamizaje y ultrasonografía duplex Doppler y/o venografía ascendente como prueba de comprobación en los casos de sospecha de TVP. La fecuencia de TVP fue significativamente más baja en el grupo de HBPM que en el grupo de dextrán (15.5% versus 32.6%,p<0.005). La TVP proximal fue infrecuente en los dos grupos (HBPM: 2%, Dextrán: 1%). Sólo se observó un caso de embolismo pulmonar fatal en el curso de profiliaxis de 10 días en un paciente que recibió dextrán. Hubo tres casos tardíos de embolismo pulmonar: uno de carácter fatal en el grupo de dextrán en el día 14, y dos casos en el grupo de HBP (uno fatal y uno no fatal) en los días 14 y 17, respectivamente. No se presentaron complicaciones de sangrado en los dos grupos. Nuestra conclusión es que la HBPM que utilizamos es un agente seguro, que fue bien tolerado y que exhibió una acción tromboprofiláctica significativamente superior que el dextrán 70.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lindblad, B.: Prophylaxis of postoperative thromboembolism with low dose heparin alone or in combination with dihydroergotamine: A review. Acta Chir. Scand. Suppl.543:31, 1988

    PubMed  Google Scholar 

  2. Svend-Hansen, H., Bremerskov, V., Gotrik, J., Ostri, P.: Low-dose heparin in proximal femoral fractures: Failure to prevent deep-vein thrombosis. Acta Orthop. Scand.52:77, 1981

    PubMed  Google Scholar 

  3. Bergqvist, D., Efsing, H.O., Hallböök, T., Hedlund, T.: Thromboembolism after elective and post-traumatic hip surgery: A controlled prophylactic trial with dextran 70 and low-dose heparin. Acta Chir. Scand.145:213, 1979

    PubMed  Google Scholar 

  4. Fredin, H., Lindblad, B., Jaroszewski, H., Bergqvist, D.: Prevention of thrombosis after hip fracture surgery. Acta Chir. Scand. 681, 1985

  5. Rorbaeck-Madsen, M., Jakobsen, B.W., Pedersen, J., Sorensen, B.: Dihydroergotamine and the thromboprophylactic effect of dextran 70 in emergency hip surgery. Br. J. Surg.75:364, 1988

    PubMed  Google Scholar 

  6. Lahnborg, G.: Effect of low-dose heparin and dihydroergotamine on frequency of postoperative deep-vein thrombosis in patients undergoing post-traumatic hip surgery. Acta Chir. Scand.145:319, 1980

    Google Scholar 

  7. Moskovitz, P.A., Ellenberg, S.S., Feffer, H.L., Kenmore, P.I., Neviaser, R.J., Ruben, B.E., Varma, V.M.: Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures. J. Bone Joint Surg.60A:1065, 1978

    PubMed  Google Scholar 

  8. Haas, S., Stemberger, A., Fritsche, H.M., Welzel, D., Wolf, H., Lechner, F., Bluemel, G.: Prophylaxis of deep-vein thrombosis in high risk patients undergoing total hip replacement with low molecular weight heparin plus dihydroergotamine. Drug. Res.37:839, 1987

    Google Scholar 

  9. Planes, A., Vochelle, N., Mazas, F., Mansat, C., Zucman, J., Landais, A., Pescariello, J.C., Weill, D., Butel, J.: Prevention of postoperative venous thrombosis: A randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb. Haemost.60:407, 1988

    PubMed  Google Scholar 

  10. Eriksson, B.I., Zachrisson, B.E., Teger-Nilsson, A.C., Risberg, B.: Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br. J. Surg.75:1053, 1988

    PubMed  Google Scholar 

  11. Levine, M.N., Hirsh, J., Gent, M., Turpie, A.G., Leclerc, J., Powers, P.J., Jay, R.M., Neemeh, J.: Prevention of deep vein thrombosis after elective hip surgery: A randomized trial comparing LMWH with standard unfractionated heparin. Ann. Intern. Med.114:545, 1991

    PubMed  Google Scholar 

  12. Lassen, M.R., Borris, L.C., Christiansen, H.M., Moller-Larsen, F., Knudsen, V.E., Boris, P., Nehen, A.M., de Carvalho, A., Jurik, A.G., Nielsen, B.W., Lucht, U.: Heparin/dihydroergotamine for venous thrombosis prophylaxis: Comparison of low-dose heparin and low molecular weight heparin in hip surgery. Br. J. Surg.75:686, 1988

    PubMed  Google Scholar 

  13. Gruber, U.F.: Prevention of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: An international multicenter study. Br. Med. J.:69, 1980

  14. Monreal, M., Lafoz, E., Navarro, A., Granero, X., Caja, V., Caceres, E., Salvador, R., Ruiz, J.: A prospective double blind trial of a low molecular weight heparin once daily compared with conventional low-dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture. J. Trauma29:873, 1989

    PubMed  Google Scholar 

  15. Lassen, M.R., Borris, L.C., Christiansen, H.M., Moller-Larsen, F., Knudsen, V.E., Boris, P., Nehen, A.M., Jurik, A.G., de Carvalho, A., Nielsen, B.W., Lucht, U.: Prevention of thromboembolism in hip-fracture patients. Arch. Orthop. Trauma Surg.108:10, 1989

    PubMed  Google Scholar 

  16. Wille-Joergensen, P., Joergensen, L.N., Lassen, M.R., Borris, L.C., Hauch, O., Nehen, A.M., Kjaer, L., Jensen, R.: Phlebography as the golden standard in thromboprophylactic studies. Thromb. Haemost65(S):Abstract 1705, 1991

  17. Büller, H.R., Lensing, A.W.A., Hirsh, J., ten Cate, J.W.: Deep vein thrombosis: New non-invasive diagnostic tests. Thromb. Haemost66:133, 1991

    PubMed  Google Scholar 

  18. Wheeler, H.B., Anderson, F.A.: Diagnostic approaches for deep vein thrombosis. Chest89(Suppl.):407, 1986

    PubMed  Google Scholar 

  19. Schindler, J.M., Kaiser, M., Gerber, A., Vuilliomenet, A., Popovic, A., Bertel, O.: Colour coded duplex sonography in suspected deep vein thrombosis of the leg. Br. Med. J.301:1369, 1990

    Google Scholar 

  20. Barsotti, J., Gruel, Y., Rosset, P., Favard, L., Dabo, B., Andreu, J., Delahousse, B., Leroy, J.: Comparative double-blind study of two dosage regimens of low molecular weight heparin in elderly patients with fracture of the neck of the femur. J. Orthop. Trauma4:371, 1990

    PubMed  Google Scholar 

  21. Pini, M., Tagliaferri, A., Manotti, C., Lasagni, F., Rinaldi, E., Dettori, A.G.: Low molecular weight heparin compared with unfractionated heparin in prevention of deep-vein thrombosis after hip fractures. Int. Angiol.8:134, 1989

    PubMed  Google Scholar 

  22. Bergqvist, D., Kettunen, K., Fredin, H., Fauno, P., Suomalainen, O.: Thromboprophylaxis in patients with hip fractures: A prospective, randomized comparative study between Org 10172 and dextran 70. Surgery109:617, 1991

    PubMed  Google Scholar 

  23. Turpie, A.G., Levine, M.N., Hirsh, J., Carter, C.J., Jay, R.M., Powers, P.J., Andrew, M., Hull, R.D., Gent, M.: A randomized controlled trial of a low-molecular-weight-heparin (Enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N. Engl. J. Med.315:925, 1986

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Surgery, Nuclear Medicine, and Angiology, University Hospital, Basel, Switzerland

    D. Oertli M.D., P. Hess, M. Dūrig, U. Laffer, R. Fridrich, K. Jaeger, R. Kaufmann & F. Harder

  2. CONSULT AG, Statistical Consulting Company, Berne, Switzerland

    D. Oertli M.D., P. Hess, M. Dūrig, U. Laffer, R. Fridrich, K. Jaeger, R. Kaufmann & F. Harder

Authors
  1. D. Oertli M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Dūrig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. U. Laffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Fridrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Jaeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Harder
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oertli, D., Hess, P., Dūrig, M. et al. Prevention of deep vein thrombosis in patients with hip fractures: Low molecular weight heparin versus dextran. World J. Surg. 16, 980–984 (1992). https://doi.org/10.1007/BF02067011

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02067011

Keywords

Search

Navigation