The Journal of Bone and Joint Surgery, Vol 71, Issue 3 327-335, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Prevention of venous thrombosis after total hip arthroplasty. Antithrombin III and low-dose heparin compared with dextran 40
CW Francis, VD Pellegrini, VJ Marder, CM Harris, S Totterman, KR Gabriel, DJ Baughman, S Roemer, J Burke, TL Goodman and al. et
University of Rochester School of Medicine and Dentistry, New York 14642.
The anticoagulant action of heparin is mediated through antithrombin III,
and the postoperative decrease in the plasma concentration of antithrombin
III may contribute to the relative ineffectiveness of prophylaxis with
low-dose heparin in preventing venous thrombosis after total hip
arthroplasty. We conducted a prospective, randomized trial to compare the
effectiveness of a regimen of antithrombin III, given intravenously once
daily, and low-dose heparin with a regimen of dextran 40, given
intravenously, in preventing venographically documented venous thrombosis
after total hip arthroplasty. The results demonstrated an incidence of
venous thrombosis of 4.9 per cent in patients who received antithrombin III
and heparin; this was significantly lower than the incidence (28.6 per
cent) in patients who received dextran 40 (p less than 0.005). Venous
thrombosis occurred only in patients who had total hip arthroplasty with a
cemented prosthesis (fourteen of fifty-seven patients, or 24.6 per cent);
none of the twenty-six patients in whom a non-cemented prosthesis was used
had venous thrombosis (p less than 0.01). Of the patients in whom a
cemented prosthesis had been inserted, the incidence of venous thrombosis
was lower in those who were treated with antithrombin III and heparin (7.4
per cent) than in those who were treated with dextran 40 (40 per cent) (p
less than 0.005). Postoperative levels of antithrombin III were maintained
at more than 90 per cent of the baseline level in patients who received it;
this was significantly higher than in patients who received dextran
40.(ABSTRACT TRUNCATED AT 250 WORDS)
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