Prevention of thromboembolism in hip-fracture patients

Lassen, Michael R.; Borris, Lars C.; Christiansen, Hanne M.; Møller-Larsen, F; Knudsen, V.; Boris, Peter; Nehen, A. K.; Jurik, Anne Grethe; Carvalho, A. De; Nielsen, Bent Windelborg; Lucht, Ulf

doi:10.1007/bf00934150

Cited by 30 publications

(4 citation statements)

References 9 publications

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“…We did not find any significant difference in DVTs between the pre-and postoperative start of prophylaxis, possibly due to the high exclusion rate. Other studies (5,11 ) claim that there is a two-puckle curve in the postoperative period, and undoubtedly the patients will benefit with prophylaxis for as long as possible, although this has not been proven significantly in any study. The low rate of DVT, only 8% proximal thrombi, indicates that thromboprophylaxis with Klexaneg is effective.…”

Section: Discussionmentioning

confidence: 93%

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Early Preoperative Thromboprophylaxis with Klexane® in Hip Fracture Surgery: A Placebo-Controlled Study

Jørgensen

Strandberg

Wille‐Jørgensen

et al. 1998

Clin Appl Thromb Hemost

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The aim of this study was to evaluate any possible benefits of early thromboprophylactic treatment in the prevention of deep vein thrombosis (DVT) in high-risk hip fracture patients. Within 30 months, 239 patients were included in a double-blind placebo-controlled study. With the diagnosis of hip fracture confirmed, patients received either 40-mg Enoxaparin s.c. or placebo once daily until operation. Postoperatively, all patients received 40-mg Enoxaparin s.c. once daily until phlebography. Phlebography was first performed on the operated leg, and with no thrombosis detected, the other leg was investigated as well. The two groups did not differ demograph-ically. Eighty-five patients were excluded. Eight patients died during the study period. The remaining 146 patients had ascending phlebography performed and 24 patients (16.4%) developed DVT. Nine (12%) of 75 patients in the Klexane® and 15 (21 %) of 72 patients in the placebo group developed DVT.The risk ratio was 0.58 (95% confidence limits 0.27-1.25) and p = .15 (X2 test). There was no difference in perioperative bleeding or transfusion requirements. We conclude that Klex-ane® is an effective and safe thromboprophylactic agent in hip fracture patients.

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Section: Discussionmentioning

confidence: 93%

“…Eight patients died during the study period. The (1)(2)(3)(4)(5)(6)(7)(8), but no study has been conducted with the aim of evaluating preoperative thromboprophylaxis. One study (8) applying preoperative phlebography proved 12% of patients developed DVT preoperatively.…”

mentioning

confidence: 99%

Early Preoperative Thromboprophylaxis with Klexane® in Hip Fracture Surgery: A Placebo-Controlled Study

Jørgensen

Strandberg

Wille‐Jørgensen

et al. 1998

Clin Appl Thromb Hemost

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“…Thromboprophylaxis with LMWH in elective total hip replacement has been investigated in several trials and has been shown to be at least as efficient as standard heparin [8,9,11]. In patients undergoing emergency surgery for hip fractures, the prophylactic effect of LMWH on DVT has not been proven consistently [14,15]. The present trial compares the thromboprophylactic efficacy and the safety of a LMWH with that of dextran 70 in a well defined high risk population of patients with hip fractures.…”

Section: Discussionmentioning

confidence: 99%

Prevention of deep vein thrombosis in patients with hip fractures: Low molecular weight heparin versus dextran

et al. 1992

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A randomized open trial was undertaken to compare the antithrombotic efficacy of a low molecular weight heparin (LMWH; Sandoparin) with that of dextran 70 in patients undergoing surgery for hip fracture. One hundred thirteen patients received LMWH once daily subcutaneously at a fixed dosage while 103 patients received intravenous dextran 70. Postoperative deep vein thrombosis (DVT) was assessed by a diagnostic algorithm using the 125Iodine fibrinogen uptake test as screening and Duplex ultrasonography and/or ascending venography as confirming techniques for suspected DVT. The frequency of DVT was significantly lower in the LMWH group than in the dextran group (15.5 versus 32.6%, p less than 0.005). Proximal DVT was rare in both groups (LMWH: 2%, Dextran: 1%). Only one case of fatal fat pulmonary embolism was observed during the 10 day prophylaxis period in a patient receiving Dextran. Three cases of pulmonary embolism occurred later; one fatal event in the dextran group on day 14, and two cases in the LMWH group (one fatal and one non-fatal event) on day 14 and 17, respectively. There was no major bleeding complication in either group. We conclude that the LMWH we used is safe, was well tolerated, and has a significantly better thromboprophylactic effect than dextran 70.

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“…[73] In addition, LMWHs have prolonged elimination half-lives, and following subcutaneous injections they have a much greater bioavailability than standard heparin. [77][78][79][80][81][82][83] The overall average risk reduction as compared with the combined estimate of the other treatment modalities was 52% (p <0.001) for LMWHs, with an incidence of postoperative DVT of approximately 15%. Since 1984, numerous randomised controlled clinical studies with LMWHs have been performed in various patient categories, including 7 in patients undergoing hip fracture surgery (table 1).…”

Section: Low Molecular Weight Heparinsmentioning

confidence: 99%

Physiological Changes Due to Age

Nurmohamed¹,

Büller²,

Cate³

1994

Drugs & Aging

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The risk of venous thromboembolism increases with age. This increasing risk is associated with a concurrent enhancement of coagulation activation and gradual development of a 'prethrombotic state'. This is reflected by increased levels of coagulation activation peptides in the elderly, as well as decreased activity of the fibrinolytic system. Moreover, with increasing age there is an increased incidence of comorbid conditions, which may, in themselves, be associated with an increased risk for the development of thrombosis. Accurate diagnostic techniques and strategies for treatment and prevention of deep vein thrombosis (DVT) are mandatory in order to prevent potentially fatal complications of DVT, such as pulmonary embolism. The feasibility of validated diagnostic techniques for detecting DVT, such as real-time B-mode ultrasonography, impedance plethysmography and contrast venography, is not significantly hampered in elderly patients. The same applies to strategies for prophylaxis and treatment of DVT, which are similar to those for younger patients, although formal studies in elderly patients with DVT are lacking.

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Prevention of thromboembolism in hip-fracture patients

Cited by 30 publications

References 9 publications

Early Preoperative Thromboprophylaxis with Klexane® in Hip Fracture Surgery: A Placebo-Controlled Study

Early Preoperative Thromboprophylaxis with Klexane® in Hip Fracture Surgery: A Placebo-Controlled Study

Prevention of deep vein thrombosis in patients with hip fractures: Low molecular weight heparin versus dextran

Physiological Changes Due to Age

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