Prevention of Fatal Postoperative Thromboembolism by Heparin Prophylaxis

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

“…* The European approach recognizes that deep vein thrombosis typically commences perioperatively and that preoperative prophylaxis optimizes antithrombotic effectiveness. 30,31 Delayed initiation (12-24 hours postoperatively) of low-molecular-weight heparin prophylaxis is standard practice in North America to minimize bleeding risk. 7,12,17,19,20,32 This disparity in clinical practice has led to the expressed need (by the International Consensus Statement) for a level 1 randomized trial evaluating the time of initiation of low-molecular-weight heparin thromboprophylaxis.…”

Timing of Initial Administration of Low-Molecular-Weight Heparin Prophylaxis Against Deep Vein Thrombosis in Patients Following Elective Hip Arthroplasty

“…[8][9][10][11][13][14][15][16]18,[21][22][23][24][26][27][28][29] The European approach recognizes that deep vein thrombosis typically originates perioperatively and that preoperative prophylaxis may optimize antithrombotic effectiveness. [30][31][32] Delayed initiation (12-24 hours postoperatively) of low-molecular-weight heparin prophylaxis is standard practice in North America to minimize bleeding risk. 7,12,17,19,20,33 This difference in clinical practice has led to the expressed need (by the International Consensus Statement) for…”

Low-Dose Heparin in Postoperative Patients

“…No one with a known bleeding diathesis or iodine sen¬ sitivity was included in the study, nor was anyone included who was receiving anticoagulants. The patients were placed in one of six categories according to anticipated operative procedure: (1) biliary and pancreatic; (2) thoracic; (3) gastrointestinal; (4) breast, head, and neck; (5) gynecologic; and (6) urologie. Assignment to the control and the treated group within each category was achieved by a computer-generated list of random pairs.…”

“…Many techniques have been used in attempts to reduce the inci¬ dence of deep vein thrombosis (DVT) and these dreaded sequels, particularly in postoperative patients. In 1970 Sharnoff and DeBiasio-reported 750 consecutive cases treated preoperatively and in the postoperative period by small doses of subcutaneously administered heparin so¬ dium, with only one death due to pulmonary embolism. This study suggested that small amounts of heparin might protect patients from thromboembolic disease with¬ out increasing the risk of hemorrhage.…”