The Journal of Bone and Joint Surgery, Vol 60, Issue 8 1065-1070, Copyright © 1978 by Journal of Bone and Joint Surgery, Inc
Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures
PA Moskovitz, SS Ellenberg, HL Feffer, PI Kenmore, RJ Neviaser, BE Rubin and VM Varma
Sixty-seven hip-arthroplasty and fifty-two hip-fracture patients
participated in a placebo-controlled randomized double-blind study on the
effects of low-dose heparin prophylaxis in the prevention of venous
thromboembolism. In this study, a positive thromboembolic event meant a
positive test by: (1) daily 125I-fibrinogen scanning, (2) contrast
venography on the tenth postoperative day, or (3) radionuclide perfusion
lung scan in confirmation of suspected clinical pulmonary emboli. Nineteen
(59.4 per cent) of thirty-two placebo-treated arthroplasty patients showed
evidence of a thromboembolic event in contrast with eight (22.9 per cent)
of thirty-five heparin-treated patients (p less than 0.003).
Heparin-treated arthroplasty patients required mean blood transfusions of
4.7 units, contrasted with a mean 3.2-unit transfusion requirement for
placebo-treated patients (p less than 0.05). The incidence of observed
bleeding complications was higher among the heparin-treated patients. Of
the twenty-three placebo-treated patients with fracturs, 39.1 per cent had
a thromboembolic event, while 41.4 per cent of the twenty-nine who received
heparin showed evidence of thromboembolism, demonstrating that low-dose
heparin afforded no protection, nor did it affect the incidence of bleeding
complications or transfusion requirements in fracture patients.
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