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Friday, March 2, 2001

Heparin found to suppress thrombogenesis

The major activation of thrombogenesis occurs during surgery on the femur when the intramedulary canal is invaded and the femoral vessels obstructed while the femur is maintained in extreme position. A single dose of unfractioned heparin (15U/Kg), administered intravenously before surgery on the femur suppresses thrombogenesis.

Researchers in scientific paper 77 said Thursday they evaluated the safety and efficacy of intraoperative heparin with hypotensive epidural anesthesia on the incidence of deep vein thrombosis (DVT) and symptomatic pulmonary embolism (PE).

They followed prospectively for three months 989 patients (1,021 hips) who received a single dose of intraoperative heparin with hypotensive epidural anesthesia. Additionally, the patients received pharmacologic prophylaxis for six weeks (aspirin 87 percent; warfarin 13 percent). No patient was lost to follow-up.

Asymptomatic DVT assessed by ultrasound in the first 198 consecutive patients showed an incidence of 7.1 percent (14 of 198). The incidence of clinical DVT in the subsequent 791 patients was 0.88 percent (seven of 989). Symptomatic PE occurred in 0.5 percent (five of 989). No patients died. One patient developed hematuria requiring a bladder flush and five units of blood, with an uneventful recovery.

The researchers said intraoperative heparin is part of a multimodal approach to prevent thromboembolic disease, which includes predonation of autologous blood, minimizing blood loss, expedient surgery and early mobilization. The results of this study compare favorably with the literature, and with a historic control of 2,592 THRs without intraoperative heparin (PE rate of 1 percent; 0.04 percent fatal). Intraoperative heparin appears safe and efficacious as thromboembolic prophylaxis. The low rate of PE observed do not support routine anticoagulation prophylaxis with drugs with a significant risk of bleeding, said the researchers.

Coauthors of the paper are Alejandro Gonzalez Della Valle, MD, New York, N.Y.; Christopher DiGiovanni, MD, Providence, R.I.; Andres Restrepo, MD, Bogota, Colombia; Nigel E. Sharrock, MB, New York, N.Y.; John P. McCabe, MD, Galway, Ireland; Thomas P. Sculco, MD, New York, N.Y.; Paul Pellicci, MD, New York, N.Y.; and Eduardo A. Salvati, MD, New York, N.Y.

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2001 Academy News March 2 Index C

Last modified 15/February/2001 by IS