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The Journal of Bone and Joint Surgery, Vol 76, Issue 12 1814-1818, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Prophylaxis for the prevention of venous thromboembolism after total knee arthroplasty. A comparison between unfractionated and low-molecular-weight heparin
P Fauno, O Suomalainen, V Rehnberg, TB Hansen, K Kroner, S Soimakallio and E Nielsen
University Hospital, Arhus, Denmark.
We compared the efficacy and safety of low-molecular-weight heparin with
that of low-dose unfractionated heparin in the prevention of venous
thromboembolism after total knee arthroplasty in a prospective, randomized,
multicenter trial. One hundred and eighty-five patients were randomly
assigned to two groups: ninety-two received low-molecular-weight heparin
(forty milligrams of enoxaparin the evening before the operation and once a
day subsequently) and ninety-three received unfractionated heparin (5000
international units the evening before the operation and three times a day
thereafter). The prophylaxis was continued until bilateral ascending
venography was performed six to nine days after the operation or, if
venography was not done, until the eighth postoperative day. Venography
revealed a prevalence of deep-vein thrombosis of 27 per cent (twenty-five
of ninety-three patients) in the group that received unfractionated heparin
and 23 per cent (twenty-one of ninety-two patients) in the group that
received low-molecular-weight heparin. The difference was not significant
(p = 0.6). Five patients (5 per cent) who received unfractionated heparin
and 3 patients (3 per cent) who received low-molecular-weight heparin had a
deep-vein thrombosis in the proximal veins. Two patients who received
unfractionated heparin and one who received low-molecular-weight heparin
had clinical symptoms suggestive of a pulmonary embolism. None of these
three patients had a positive ventilation-perfusion scan. There were no
deaths, major bleeding episodes, or wound hematomas necessitating operative
intervention or discontinuation of the anticoagulation in the
series.(ABSTRACT TRUNCATED AT 250 WORDS)
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