This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
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 Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by DELLA VALLE, C. J.
Right arrow Articles by DI CESARE, P. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by DELLA VALLE, C. J.
Right arrow Articles by DI CESARE, P. E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?
The Journal of Bone and Joint Surgery 82:207-12 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Anticoagulant Treatment of Thromboembolism with Intravenous Heparin Therapy in the Early Postoperative Period Following Total Joint Arthroplasty*

CRAIG J. DELLA VALLE, M.D.{dagger}, LAITH M. JAZRAWI, M.D.{dagger}, JEREMY IDJADI, B.A.{dagger}, RUDI N. HIEBERT, M.S.{dagger}, STEVEN A. STUCHIN, M.D.{dagger}, DAVID J. STEIGER, M.D.{dagger} and PAUL E. DI CESARE, M.D.{dagger}, NEW YORK, N.Y.

Investigation performed at the Department of Orthopaedic Surgery, New York University—Hospital for Joint Diseases, New York City

Background: Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation.

Methods: The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy.

Results: The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001).

Conclusions: The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Med Decis MakingHome page
A. S. Dunn, J. Wisnivesky, W. Ho, C. Moore, T. McGinn, and H. S. Sacks
Perioperative Management of Patients on Oral Anticoagulants: A Decision Analysis
Med Decis Making, July 1, 2005; 25(4): 387 - 397.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
A. S. Dunn and A. G. G. Turpie
Perioperative Management of Patients Receiving Oral Anticoagulants: A Systematic Review
Arch Intern Med, April 28, 2003; 163(8): 901 - 908.
[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]