The Incidence of Symptomatic Venous Thromboembolism After Enoxaparin Prophylaxis in Lower Extremity Arthroplasty
1998; Elsevier BV; Volume: 114; Issue: 2 Linguagem: Inglês
10.1378/chest.114.2_supplement.115s
ISSN1931-3543
AutoresJacques R. Leclerc, M Gent, Jack Hirsh, William Geerts, Jeffrey S. Ginsberg,
Tópico(s)Shoulder Injury and Treatment
ResumoLow-molecular-weight heparins (LMWHs) safely reduce the incidence of venous thromboembolism after major orthopedic surgery. 1 Lieberman JR Geerts WH Prevention of venous thromboembolism after total hip and knee arthroplasty. J Bone Joint Surg Am. 1994; 76: 1239-1250 Crossref PubMed Scopus (124) Google Scholar , 2 Turpie AGG Levine MN Hirsh J et al. A randomized controlled trial of a low molecular weight heparin (enoxaparin) to prevent deep vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986; 315: 925-929 Crossref PubMed Scopus (462) Google Scholar , 3 Hoek JA Nurmohamed MT Hamelynck KJ et al. Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid. Thromb Haemost. 1992; 67: 28-32 PubMed Google Scholar , 4 Lassen MR Borris LC Christiansen HM et al. Prevention of thromboembolism in 190 hip arthroplasties: comparison of LMW heparin and placebo. Acta Orthop Scand. 1991; 62: 33-38 Crossref PubMed Scopus (132) Google Scholar , 5 Leclerc JR Geerts WH Desjardins L et al. Prevention of deep vein thrombosis after major knee surgery: a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost. 1992; 67: 417-423 Crossref PubMed Scopus (202) Google Scholar , 6 Planes A Vochelle N Mazas F et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost. 1988; 60: 407-410 Crossref PubMed Scopus (240) Google Scholar , 7 Levine MN Hirsh J Gent M et al. Prevention of deep vein thrombosis after elective hip surgery: a randomized trial comparing low molecular weight heparin with standard unfractionated heparin. Ann Intern Med. 1991; 114: 545-551 Crossref PubMed Scopus (286) Google Scholar , 8 The Danish Enoxaparin Study GroupLow-molecular weight heparin (enoxaparin) vs dextran 70: the prevention of postoperative deep vein thrombosis after total hip replacement. Arch Intern Med. 1991; 151: 1621-1624 Crossref PubMed Scopus (97) Google Scholar , 9 Leyvraz PF Bachmann F Hoek J et al. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ. 1991; 303: 543-548 Crossref PubMed Scopus (225) Google Scholar , 10 Prevention of deep vein thrombosis with low molecular-weight heparin in patients undergoing total hip replacement: a randomized trialThe German Hip Arthroplasty Trial (GHAT) Group. Arch Orthop Trauma Surg. 1992; 111: 110-120 Crossref PubMed Scopus (104) Google Scholar , 11 Hull R Raskob G Pineo G et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993; 329: 1370-1376 Crossref PubMed Scopus (449) Google Scholar , 12 Planes A Chastang C Vochelle N et al. Comparison of antithrombotic efficacy and haemorrhagic side-effects of Clivarin versus enoxaparin in patients undergoing total hip replacement surgery. Blood Coagul Fibrinolysis. 1993; 4: S33-35 PubMed Google Scholar , 13 Mohr D Silverstein M Murtaugh P et al. Prophylactic agents for venous thrombosis in elective hip surgery: meta-analysis of studies using venographic assessment. Arch Intern Med. 1993; 153: 2221-2228 Crossref PubMed Scopus (103) Google Scholar , 14 Spiro TE Johnson GJ Christie MJ et al. Efficacy and safety of enoxaparin to prevent deep venous thrombosis after hip replacement surgery. Ann Intern Med. 1994; 121: 81-89 Crossref PubMed Scopus (117) Google Scholar , 15 The RD Heparin Arthroplasty GroupRD heparin compared with warfarin for prevention of venous thromboembolic disease following total hip or knee arthroplasty. J Bone Joint Surg Am. 1994; 76: 1174-1185 Crossref PubMed Scopus (169) Google Scholar , 16 Colwell CW Spiro TE Trowbridge AA et al. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement: a clinical trial comparing efficacy and safety. J Bone Joint Surg Am. 1994; 76: 3-14 Crossref PubMed Scopus (222) Google Scholar , 17 Fauno P Suomalainen O Rehnberg V et al. Prophylaxis for the prevention of venous thromboembolism after total knee arthroplasty: a comparison between unfractionated and low-molecular weight heparin. J Bone Joint Surg Am. 1994; 76: 1814-1818 Crossref PubMed Scopus (87) Google Scholar , 18 Spiro TE Fitzgerald RH Trowbridge AA et al. Enoxaparin, a low molecular weight heparin and warfarin for the prevention of venous thromboembolic disease after elective knee replacement surgery [abstract]. Blood. 1994; 84: 246 Google Scholar , 19 Heit J Berkowitz S Bona R et al. Efficacy and safety of normiflo (a low molecular weight heparin) for prevention of venous thromboembolism following total knee replacement: a double-blind, dose-ranging study [abstract]. Thromb Haemost. 1995; 73: 978 Google Scholar , 20 Leclerc JR Geerts WH Desjardins L et al. Prevention of venous thromboembolism after knee arthroplasty: a randomized, double-blind trial comparing enoxaparin to warfarin. Ann Intern Med. 1996; 124: 619-626 Crossref PubMed Scopus (247) Google Scholar , 21 Planes A Vochelle N Darmon J-Y et al. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996; 348: 224-228 Abstract Full Text Full Text PDF PubMed Scopus (476) Google Scholar , 22 Bergqvist D Benoni G Bjorgell O et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996; 335: 696-700 Crossref PubMed Scopus (488) Google Scholar Despite LMWH prophylaxis, however, approximately 15% of patients undergoing hip arthroplasty and 30% of those undergoing knee arthroplasty have venographic evidence of deep vein thrombosis (DVT) at the time of hospital discharge. 1 Lieberman JR Geerts WH Prevention of venous thromboembolism after total hip and knee arthroplasty. J Bone Joint Surg Am. 1994; 76: 1239-1250 Crossref PubMed Scopus (124) Google Scholar , 2 Turpie AGG Levine MN Hirsh J et al. A randomized controlled trial of a low molecular weight heparin (enoxaparin) to prevent deep vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986; 315: 925-929 Crossref PubMed Scopus (462) Google Scholar , 3 Hoek JA Nurmohamed MT Hamelynck KJ et al. Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid. Thromb Haemost. 1992; 67: 28-32 PubMed Google Scholar , 4 Lassen MR Borris LC Christiansen HM et al. Prevention of thromboembolism in 190 hip arthroplasties: comparison of LMW heparin and placebo. Acta Orthop Scand. 1991; 62: 33-38 Crossref PubMed Scopus (132) Google Scholar , 5 Leclerc JR Geerts WH Desjardins L et al. Prevention of deep vein thrombosis after major knee surgery: a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost. 1992; 67: 417-423 Crossref PubMed Scopus (202) Google Scholar , 6 Planes A Vochelle N Mazas F et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost. 1988; 60: 407-410 Crossref PubMed Scopus (240) Google Scholar , 7 Levine MN Hirsh J Gent M et al. Prevention of deep vein thrombosis after elective hip surgery: a randomized trial comparing low molecular weight heparin with standard unfractionated heparin. Ann Intern Med. 1991; 114: 545-551 Crossref PubMed Scopus (286) Google Scholar , 8 The Danish Enoxaparin Study GroupLow-molecular weight heparin (enoxaparin) vs dextran 70: the prevention of postoperative deep vein thrombosis after total hip replacement. Arch Intern Med. 1991; 151: 1621-1624 Crossref PubMed Scopus (97) Google Scholar , 9 Leyvraz PF Bachmann F Hoek J et al. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ. 1991; 303: 543-548 Crossref PubMed Scopus (225) Google Scholar , 10 Prevention of deep vein thrombosis with low molecular-weight heparin in patients undergoing total hip replacement: a randomized trialThe German Hip Arthroplasty Trial (GHAT) Group. Arch Orthop Trauma Surg. 1992; 111: 110-120 Crossref PubMed Scopus (104) Google Scholar , 11 Hull R Raskob G Pineo G et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993; 329: 1370-1376 Crossref PubMed Scopus (449) Google Scholar , 12 Planes A Chastang C Vochelle N et al. Comparison of antithrombotic efficacy and haemorrhagic side-effects of Clivarin versus enoxaparin in patients undergoing total hip replacement surgery. Blood Coagul Fibrinolysis. 1993; 4: S33-35 PubMed Google Scholar , 13 Mohr D Silverstein M Murtaugh P et al. Prophylactic agents for venous thrombosis in elective hip surgery: meta-analysis of studies using venographic assessment. Arch Intern Med. 1993; 153: 2221-2228 Crossref PubMed Scopus (103) Google Scholar , 14 Spiro TE Johnson GJ Christie MJ et al. Efficacy and safety of enoxaparin to prevent deep venous thrombosis after hip replacement surgery. Ann Intern Med. 1994; 121: 81-89 Crossref PubMed Scopus (117) Google Scholar , 15 The RD Heparin Arthroplasty GroupRD heparin compared with warfarin for prevention of venous thromboembolic disease following total hip or knee arthroplasty. J Bone Joint Surg Am. 1994; 76: 1174-1185 Crossref PubMed Scopus (169) Google Scholar , 16 Colwell CW Spiro TE Trowbridge AA et al. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement: a clinical trial comparing efficacy and safety. J Bone Joint Surg Am. 1994; 76: 3-14 Crossref PubMed Scopus (222) Google Scholar , 17 Fauno P Suomalainen O Rehnberg V et al. Prophylaxis for the prevention of venous thromboembolism after total knee arthroplasty: a comparison between unfractionated and low-molecular weight heparin. J Bone Joint Surg Am. 1994; 76: 1814-1818 Crossref PubMed Scopus (87) Google Scholar , 18 Spiro TE Fitzgerald RH Trowbridge AA et al. Enoxaparin, a low molecular weight heparin and warfarin for the prevention of venous thromboembolic disease after elective knee replacement surgery [abstract]. Blood. 1994; 84: 246 Google Scholar , 19 Heit J Berkowitz S Bona R et al. Efficacy and safety of normiflo (a low molecular weight heparin) for prevention of venous thromboembolism following total knee replacement: a double-blind, dose-ranging study [abstract]. Thromb Haemost. 1995; 73: 978 Google Scholar , 20 Leclerc JR Geerts WH Desjardins L et al. Prevention of venous thromboembolism after knee arthroplasty: a randomized, double-blind trial comparing enoxaparin to warfarin. Ann Intern Med. 1996; 124: 619-626 Crossref PubMed Scopus (247) Google Scholar , 21 Planes A Vochelle N Darmon J-Y et al. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996; 348: 224-228 Abstract Full Text Full Text PDF PubMed Scopus (476) Google Scholar , 22 Bergqvist D Benoni G Bjorgell O et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996; 335: 696-700 Crossref PubMed Scopus (488) Google Scholar In addition, 20 to 40% of patients develop new thrombi after hospital discharge, as shown by venography 3 weeks later. 21 Planes A Vochelle N Darmon J-Y et al. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996; 348: 224-228 Abstract Full Text Full Text PDF PubMed Scopus (476) Google Scholar , 22 Bergqvist D Benoni G Bjorgell O et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996; 335: 696-700 Crossref PubMed Scopus (488) Google Scholar The clinical importance of postoperative venous thrombi that occur despite in-hospital prophylaxis is unknown, although the majority of these thrombi remain asymptomatic. However, since they have the potential to grow and become symptomatic, it has been suggested that in-hospital prophylaxis alone may not provide adequate protection in patients undergoing major orthopedic procedures. 21 Planes A Vochelle N Darmon J-Y et al. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996; 348: 224-228 Abstract Full Text Full Text PDF PubMed Scopus (476) Google Scholar , 22 Bergqvist D Benoni G Bjorgell O et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996; 335: 696-700 Crossref PubMed Scopus (488) Google Scholar
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