Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery

Abstract

In a prospective, double-blind controlled study we have compared the prophylactic efficacy against deep vein thrombosis of low-dose heparin + dihydroergotamine (A), low molecular weight heparin + dihydroergotamine (B) and placebo (C). A total of three hundred and fifty-six patients undergoing total hip replacement were randomized into three groups and 316 patients were analysed. All thrombi were verified by ascending phlebography. One-third of the patients developed deep vein thrombosis in group A and B, differing significantly from group C. The operative blood loss in group B was higher than that in groups A and C. However, the number of patients transfused and their transfusion requirements did not differ. Severe bleeding occurred in one patient in each group. No deaths were registered during the study. Our study indicates that prophylactic treatment against postoperative deep vein thrombosis with low molecular weight heparin + dihydroergotamine once daily is as effective and safe as conventional low-dose heparin + dihydroergotamine twice daily in patients undergoing total hip replacement. The once-daily regimen has the advantage of better patient acceptance and less nursing time.

Postoperative Versus Preoperative Initiation of Deep-Vein Thrombosis Prophylaxis with a Low-Molecular-Weight Heparin (Nadroparin) in Elective Hip Replacement

“…This figure is slightly lower than that recorded in the GHAT study (10.3%), though it is higher than the extremely low one obtained by Leyvraz et al (2.8% (8) and consistent with those (ranging from 5.4% to 8.2%) recorded in other elective hip surgery prophylaxis studies, where different LMWH dosage schedules were adopted (4,5,(18)(19)(20).…”

Thromboprophylaxis with Heparin and Low Molecular Weight Heparin in Elective Hip Surgery: Current Status and Perspectives

“…[2][3][4][5][6] We added the results of some recent comparative trials with placebo-treated or untreated patient groups. [7][8][9][10][11] The astonishing fact was that we could confirm Bergqvist's results ( Table 1, Fig. 1).…”

Efficacy and Safety of Low Molecular Weight Heparin, Unfractionated Heparin and Warfarin for Thrombo-Embolism Prophylaxis in Orthopaedic Surgery: A Meta-Analysis of Randomised Clinical Trials

“…[35] open, randomised DVT diagnosed by FUT only, no bleeding information Hesset al [27] open, randomised double publication -also reported as Oertli et al [8] Lassen ct al. [28] double blind, randomised patients studied arc a subset of patients from the article by Lassen et al [ 12] Lcclercet al [30] double blind, randomised DVT not diagnosed in all cases by phlebography, insufficient bleeding information Matzsch et al [31] open, randomised no figures for DVT diagnosed by phlebography, insufficient bleeding information Gerhart et al [32] randomised, open label, prospective insufficient information regarding DVT diagnosis, combined treatment with both warfarin and LMWH after post-operative day 5. Bergqvist [33] randomised, open label, prospective discussion of results of Gerhart et al [32] Heit et al [34] open label, prospective, multicentre double publication of RD Heparin Group [23].…”