This Article
Right arrow Full Text (PDF)
Right arrow A correction has been published
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Colwell, C.
Right arrow Articles by Skoutakis, V.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Colwell, C.
Right arrow Articles by Skoutakis, V.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

The Journal of Bone and Joint Surgery, Vol 76, Issue 1 3-14, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. A clinical trial comparing efficacy and safety. Enoxaparin Clinical Trial Group

CW Colwell, TE Spiro, AA Trowbridge, BA Morris, HC Kwaan, JD Blaha, AJ Comerota and VA Skoutakis
Scripps Clinic and Research Foundation, La Jolla, California 92037.

A randomized, parallel-group, open-label clinical trial (the physicians, patients, and staff were not blinded with regard to the regimen that had been used) was conducted, between December 1988 and September 1990, to compare the safety and efficacy of enoxaparin, a low-molecular-weight heparin, with the safety and efficacy of unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. Six hundred and ten patients were randomized, and 607 patients received one of the study medications. The evaluations of efficacy included contrast-media venography, non-invasive vascular examination, and clinical examination. Data on efficacy were available for 604 patients, who had been assigned to one of three treatment groups: thirty milligrams of enoxaparin every twelve hours (194 patients), forty milligrams of enoxaparin once daily (203 patients), or 5000 units of unfractionated heparin every eight hours (207 patients). All drugs were administered subcutaneously. Dosages were not adjusted on the basis of the results of coagulation tests or the body weight of the patient. Treatment was initiated within twenty-four hours after the operation and continued for a maximum of seven days. The primary safety outcome was the occurrence of bleeding episodes. An intent-to-treat patient analysis revealed that deep venous thrombosis occurred in nine (5 per cent) of the 194 patients who received thirty milligrams of enoxaparin every twelve hours, thirty (15 per cent) of the 203 patients who received forty milligrams of enoxaparin once daily, and twenty-four (12 per cent) of the 207 patients who received unfractionated heparin. The rate of deep venous thrombosis was significantly lower in the group that received thirty milligrams of enoxaparin every twelve hours than in the group that received unfractionated heparin (p = 0.03) and in the group that received forty milligrams of enoxaparin once daily (p = 0.0002). No clinically symptomatic pulmonary embolism was observed during the treatment or follow-up phase of this study in the group that received thirty milligrams of enoxaparin every twelve hours. Analysis of evaluable patients revealed a marked reduction in the rate of deep venous thrombosis in the group that received thirty milligrams of enoxaparin every twelve hours (eight [6 per cent] of 136 patients) compared with the group that received heparin (twenty-one [15 per cent] of 145 patients) (p = 0.10); however, this difference was not significant because of the small number of patients included in this analysis.(ABSTRACT TRUNCATED AT 400 WORDS)
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 ChestHome page
W. H. Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, and C. W. Colwell
Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 381S - 453S.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
V. F. Tapson
Acute Pulmonary Embolism
N. Engl. J. Med., March 6, 2008; 358(10): 1037 - 1052.
[Full Text] [PDF]

Home page
 JBJSHome page
S. S. Nathan, K. A. Simmons, P. P. Lin, L. E. Hann, C. D. Morris, E. A. Athanasian, P. J. Boland, and J. H. Healey
Proximal Deep Vein Thrombosis After Hip Replacement for Oncologic Indications
J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1066 - 1070.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
A. K. Lilikakis, T. Papapolychroniou, G. Macheras, and E. Michelinakis
Thrombocytopenia and Intra-cerebral Complications Associated with Low-Molecular-Weight Heparin Treatment in Patients Undergoing Total Hip Replacement. A Report of Two Cases
J. Bone Joint Surg. Am., March 1, 2006; 88(3): 634 - 638.
[Full Text] [PDF]

Home page
 BloodHome page
N. Martel, J. Lee, and P. S. Wells
Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis
Blood, October 15, 2005; 106(8): 2710 - 2715.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
J. C. Rowlingson and P. B. Hanson
Neuraxial Anesthesia and Low-Molecular-Weight Heparin Prophylaxis in Major Orthopedic Surgery in the Wake of the Latest American Society of Regional Anesthesia Guidelines
Anesth. Analg., May 1, 2005; 100(5): 1482 - 1488.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
G. Agnelli
Prevention of Venous Thromboembolism in Surgical Patients
Circulation, December 14, 2004; 110(24_suppl_1): IV-4 - IV-12.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
W. H. Geerts, G. F. Pineo, J. A. Heit, D. Bergqvist, M. R. Lassen, C. W. Colwell, and J. G. Ray
Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest, September 1, 2004; 126(3_suppl): 338S - 400S.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
N. Strebel, M. Prins, G. Agnelli, and H. R. Buller
Preoperative or Postoperative Start of Prophylaxis for Venous Thromboembolism With Low-Molecular-Weight Heparin in Elective Hip Surgery?
Arch Intern Med, July 8, 2002; 162(13): 1451 - 1456.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. D. Douketis, J. W. Eikelboom, D. J. Quinlan, A. R. Willan, and M. A. Crowther
Short-Duration Prophylaxis Against Venous Thromboembolism After Total Hip or Knee Replacement: A Meta-analysis of Prospective Studies Investigating Symptomatic Outcomes
Arch Intern Med, July 8, 2002; 162(13): 1465 - 1471.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
T. P. Sculco, C. W. Colwell Jr., V. D. Pellegrini Jr., G. H. Westrich, and F. Bottner
Prophylaxis Against Venous Thromboembolic Disease in Patients Having a Total Hip or Knee Arthroplasty
J. Bone Joint Surg. Am., March 1, 2002; 84(3): 466 - 477.
[Full Text]

Home page
 ANN INTERN MEDHome page
R. D. Hull, G. F. Pineo, P. D. Stein, A. F. Mah, S. M. MacIsaac, O. E. Dahl, M. Butcher, R. F. Brant, W. A. Ghali, D. Bergqvist, et al.
Extended Out-of-Hospital Low-Molecular-Weight Heparin Prophylaxis against Deep Venous Thrombosis in Patients after Elective Hip Arthroplasty: A Systematic Review
Ann Intern Med, November 20, 2001; 135(10): 858 - 869.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
R. D. Hull, G. F. Pineo, P. D. Stein, A. F. Mah, S. M. MacIsaac, O. E. Dahl, W. A. Ghali, M. S. Butcher, R. F. Brant, D. Bergqvist, et al.
Timing of Initial Administration of Low-Molecular-Weight Heparin Prophylaxis Against Deep Vein Thrombosis in Patients Following Elective Hip Arthroplasty: A Systematic Review
Arch Intern Med, September 10, 2001; 161(16): 1952 - 1960.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
P. C. Comp, T. E. Spiro, R. J. Friedman, T. L. Whitsett, G. J. Johnson, G. A. Gardiner, G. C. Landon, and M. Jové
Prolonged Enoxaparin Therapy to Prevent Venous Thromboembolism After Primary Hip or Knee Replacement
J. Bone Joint Surg. Am., March 1, 2001; 83(3): 336 - 336.
[Abstract] [Full Text]

Home page
 ChestHome page
W. H. Geerts, J. A. Heit, G. P. Clagett, G. F. Pineo, C. W. Colwell, F. A. Anderson Jr., and H. B. Wheeler
Prevention of Venous Thromboembolism
Chest, January 1, 2001; 119(1_suppl): 132S - 175S.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
R. D. Hull, G. F. Pineo, C. Francis, D. Bergqvist, C. Fellenius, K. Soderberg, A. Holmqvist, M. Mant, R. Dear, B. Baylis, et al.
Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients: A Double-blind, Randomized Comparison
Arch Intern Med, July 24, 2000; 160(14): 2199 - 2207.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
R. D. Hull, G. F. Pineo, C. Francis, D. Bergqvist, C. Fellenius, K. Soderberg, A. Holmqvist, M. Mant, R. Dear, B. Baylis, et al.
Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin Extended Out-of-Hospital vs In-Hospital Warfarin/Out-of-Hospital Placebo in Hip Arthroplasty Patients: A Double-blind, Randomized Comparison
Arch Intern Med, July 24, 2000; 160(14): 2208 - 2215.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
K. B. Freedman, K. R. Brookenthal, R. H. Fitzgerald, S. Williams, and J. H. Lonner
A Meta-Analysis of Thromboembolic Prophylaxis Following Elective Total Hip Arthroplasty
J. Bone Joint Surg. Am., July 1, 2000; 82(7): 929 - 929.
[Abstract] [Full Text]

Home page
 JBJSHome page
E. A. SALVATI, V. D. PELLEGRINI, N. E. SHARROCK, P. A. LOTKE, D. W. MURRAY, H. POTTER, and G. H. WESTRICH
Symposium - Recent Advances in Venous Thromboembolic Prophylaxis During and After Total Hip Replacement
J. Bone Joint Surg. Am., February 1, 2000; 82(2): 252 - 70.
[Full Text]

Home page
 JBJSHome page
C. W. COLWELL, D. K. COLLIS, R. PAULSON, J. W. McCUTCHEN, G. T. BIGLER, S. LUTZ, and M. E. HARDWICK
Comparison of Enoxaparin and Warfarin for the Prevention of Venous Thromboembolic Disease After Total Hip Arthroplasty. Evaluation During Hospitalization and Three Months After Discharge
J. Bone Joint Surg. Am., July 1, 1999; 81(7): 932 - 40.
[Abstract] [Full Text]

Home page
 JBJSHome page
A. SARMIENTO and A. D. K. GOSWAMI
Thromboembolic Prophylaxis with Use of Aspirin, Exercise, and Graded Elastic Stockings or Intermittent Compression Devices in Patients Managed with Total Hip Arthroplasty
J. Bone Joint Surg. Am., March 1, 1999; 81(3): 339 - 46.
[Abstract] [Full Text]

Home page
 Arch Intern MedHome page
R. D. Hull, R. F. Brant, G. F. Pineo, P. D. Stein, G. E. Raskob, and K. A. Valentine
Preoperative vs Postoperative Initiation of Low-Molecular-Weight Heparin Prophylaxis Against Venous Thromboembolism in Patients Undergoing Elective Hip Replacement
Arch Intern Med, January 25, 1999; 159(2): 137 - 141.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. R. Leclerc, M. Gent, J. Hirsh, W. H. Geerts, J. S. Ginsberg, and for the Canadian Collaborative Group
The Incidence of Symptomatic Venous Thromboembolism During and After Prophylaxis With Enoxaparin: A Multi-institutional Cohort Study of Patients Who Underwent Hip or Knee Arthroplasty
Arch Intern Med, April 27, 1998; 158(8): 873 - 878.
[Abstract] [Full Text] [PDF]

Home page
 CLIN APPL THROMB HEMOSTHome page
R. D. Hull and G. F. Pineo
Prophylaxis of Deep Vein Thrombosis and Pulmonary Embolism: Current Recommendations
Clinical and Applied Thrombosis/Hemostasis, April 1, 1998; 4(2): 96 - 104.
[Abstract] [PDF]

Home page
 NEJMHome page
J. Robb and B. I. Eriksson
Recombinant Hirudin Compared with Low-Molecular-Weight Heparin to Prevent Thromboembolic Complications after Total Hip Replacement
N. Engl. J. Med., March 26, 1998; 338(13): 920 - 921.
[Full Text]

Home page
 JBJSHome page
H. D. CLARKE, D. J. BERRY, and D. R. LARSON
Acute Pseudo-Obstruction of the Colon as a Postoperative Complication of Hip Arthroplasty
J. Bone Joint Surg. Am., November 1, 1997; 79(11): 1642 - 7.
[Abstract] [Full Text]

Home page
 JBJSHome page
C. W. FRANCIS, V. D. PELLEGRINI JR., S. TOTTERMAN, A. D. BOYD JR., V. J. MARDER, K. M. LIEBERT, B. N. STULBERG, D. C. AYERS, A. ROSENBERG, C. KESSLER, et al.
Prevention of Deep-Vein Thrombosis after Total Hip Arthroplasty. Comparison of Warfarin and Dalteparin
J. Bone Joint Surg. Am., September 1, 1997; 79(9): 1365 - 72.
[Abstract] [Full Text]

Home page
 JBJSHome page
B. I. ERIKSSON, S. EKMAN, S. LINDBRATT, M. BAUR, D. BACH, C. TØRHOLM, P. KÄLEBO, and P. CLOSE
Prevention of Thromboembolism with Use of Recombinant Hirudin. Results of a Double-Blind, Multicenter Trial Comparing the Efficacy of Desirudin (Revasc) with That of Unfractionated Heparin in Patients Having a Total Hip Replacement
J. Bone Joint Surg. Am., March 1, 1997; 79(3): 326 - 33.
[Abstract] [Full Text]

Home page
 JBJSHome page
D. C. AYERS, D. A. DENNIS, N. A. JOHANSON, and V. D. PELLEGRINI JR.
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Common Complications of Total Knee Arthroplasty*{{dagger}}
J. Bone Joint Surg. Am., February 1, 1997; 79(2): 278 - 311.
[Full Text]

Home page
 JBJSHome page
S. T. WOOLSON
Intermittent Pneumatic Compression Prophylaxis for Proximal Deep Venous Thrombosis after Total Hip Replacement
J. Bone Joint Surg. Am., November 1, 1996; 78(11): 1735 - 40.
[Abstract] [Full Text]

Home page
 ANN INTERN MEDHome page
J. R. Leclerc, W. H. Geerts, L. Desjardins, G. H. Laflamme, B. l'Esperance, C. Demers, J. Kassis, M. Cruickshank, L. Whitman, and F. Delorme
Prevention of Venous Thromboembolism after Knee Arthroplasty: A Randomized, Double-Blind Trial Comparing Enoxaparin with Warfarin
Ann Intern Med, April 1, 1996; 124(7): 619 - 626.
[Abstract] [Full Text]

Home page
 NEJMHome page
T. E. Warkentin, M. N. Levine, J. Hirsh, P. Horsewood, R. S. Roberts, M. Gent, and J. G. Kelton
Heparin-Induced Thrombocytopenia in Patients Treated with Low-Molecular-Weight Heparin or Unfractionated Heparin
N. Engl. J. Med., May 18, 1995; 332(20): 1330 - 1336.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
J. Hirsh, P. A. Lotke, M. L. Ecker, R. D. Hull, and G. F. Pineo
Low-Molecular-Weight Heparin vs. Warfarin for Prophylaxis against Deep-Vein Thrombosis
N. Engl. J. Med., March 24, 1994; 330(12): 862 - 863.
[Full Text]