Comparing the Effectiveness Results of Heparin and Enoxaparin after Total Hip Artroplasty

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Orthopedic Surgery, School of Medicine, Jundishapour University of Medical Sciences, Ahvaz, Iran

2 Specialist in Community Medicine, Researcher, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: One of the most important complications of immobilization is deep vein thrombosis (DVT), especially in lower extremities, and major surgeries, especially orthopaedic surgery. The aim of this study was comparing the effectiveness of heparin among short-time (10 days) and long-time (20 days) enoxaparine administration to introdue more suitable preventive method.Methods: In a prospective study, 120 patients underwent hip arthroplasty enrolled in three groups; group I recieved 5000 IU heparin three times daily (ter die sumendum or TDS), Group II recieved 40 mg enoxaparine daily for 10 days, and Group III received 40 mg enoxaparine daily for 20 days. After data collection by check list, the ANOVA and χ2 tests were used for analysis. P-value less than 0.05 was considered significant.Findings: Incidence of deep vein thrombosis in group III was reduced more than group I after hip replacement surgery. Also, pulmonary thromboembolism (PTE) was reduced in group III more than group II. PTE and postoperative death were not significantly different among enoxaparin and heparin groups.Conclusion: Enoxaparin is more effective than standard heparin in reducing pulmonary thromboembolism and deep vein thrombosis.

Keywords

References

  1. Markovic-Denic L, Zivkovic K, Lesic A, Bumbasirevic V, Dubljanin-Raspopovic E, Bumbasirevic M. Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study. Int Orthop 2012; 36(6): 1299-305.
  2. Kumar S. Venous thromboembolism in major lower limb orthopedic surgery. Indian J Orthop 2013; 47(2): 115-6.
  3. Chotanaphuti T, Foojareonyos T, Panjapong S, Reumthantong A. Incidence of deep vein thrombosis in postoperative hip fracture patients in Phramongkutklao Hospital. J Med Assoc Thai 2005; 88(Suppl 3): S159-S163.
  4. Rafee A, Herlikar D, Gilbert R, Stockwell RC, McLauchlan GJ. D-Dimer in the diagnosis of deep vein thrombosis following total hip and knee replacement: a prospective study. Ann R Coll Surg Engl 2008; 90(2): 123-6.
  5. Wong KL, Daguman R, Lim K, Shen L, Lingaraj K. Incidence of deep vein thrombosis following total hip arthroplasty: a Doppler ultrasonographic study. J Orthop Surg (Hong Kong) 2011; 19(1): 50-3.
  6. Sobieraj DM, Coleman CI, Tongbram V, Chen W, Colby J, Lee S, et al. Comparative effectiveness of combined pharmacologic and mechanical thromboprophylaxis versus either method alone in major orthopedic surgery: a systematic review and meta-analysis. Pharmacotherapy 2013; 33(3): 275-83.
  7. Mehta KV, Lee HC, Loh JS. Mechanical thromboprophylaxis for patients undergoing hip fracture surgery. J Orthop Surg (Hong Kong) 2010; 18(3): 287-9.
  8. Sobieraj DM, Coleman CI, Tongbram V, Chen W, Colby J, Lee S, et al. Comparative effectiveness of low-molecular-weight heparins versus other anticoagulants in major orthopedic surgery: a systematic review and meta-analysis. Pharmacotherapy 2012; 32(9): 799-808.
  9. Selby R, Borah BJ, McDonald HP, Henk HJ, Crowther M, Wells PS. Impact of thromboprophylaxis guidelines on clinical outcomes following total hip and total knee replacement. Thromb Res 2012; 130(2): 166-72.
  10. Sobieraj DM, Lee S, Coleman CI, Tongbram V, Chen W, Colby J, et al. Prolonged versus standard-duration venous thromboprophylaxis in major orthopedic surgery: a systematic review. Ann Intern Med 2012; 156(10): 720-7.
  11. Struijk-Mulder MC, Ettema HB, Verheyen CC, Buller HR. Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery. J Thromb Haemost 2010; 8(4): 678-83.
  12. Boneu B. Low molecular weight heparins: are they superior to unfractionated heparins to prevent and to treat deep vein thrombosis? Thromb Res 2000; 100(2): V113-V120.
  13. Hirsh J, Buchanan MR. Comparative effects of heparin and LMW heparin on hemostasis. Thromb Res Suppl 1991; 14: 11-7.
  14. Sheth NP, Lieberman JR, Della Valle CJ. DVT prophylaxis in total joint reconstruction. Orthop Clin North Am 2010; 41(2): 273-80.
  15. Maruthappu M, Nagendran M, Sugand K, Bulstrode CK. A review of the evidence for and against thromboprophylaxis in total hip replacement. Acta Orthop Belg 2011; 77(5): 583-9.
  16. Linkins LA, Julian JA, Rischke J, Hirsh J, Weitz JI. In vitro comparison of the effect of heparin, enoxaparin and fondaparinux on tests of coagulation. Thromb Res 2002; 107(5): 241-4.
  17. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e278S-e325S.
  18. Anderson DR, O'Brien BJ, Levine MN, Roberts R, Wells PS, Hirsh J. Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Ann Intern Med 1993; 119(11): 1105-12.
  19. Nurmohamed MT, Rosendaal FR, Buller HR, Dekker E, Hommes DW, Vandenbroucke JP, et al. Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet 1992; 340(8812): 152-6.
Journal of Isfahan Medical School
Volume 31, Issue 231 - Serial Number 231
March and April 2013
Pages 381-388

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History

  • Receive Date: 17 March 2013
  • Revise Date: 02 May 2024
  • Accept Date: 06 April 2022

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