Changes of D-dimer after total hip arthroplasty in patients with and without intraoperative heparin.

Abstract

INTRODUCTION:

Marked activation of thrombosis is common in patients undergoing total hip arthroplasty, especially during reaming of the femur and after insertion of the femoral prosthesis. This suggests that management designed to minimize deep vein thrombosis and fatal pulmonary embolism after total hip arthroplasty should be focused on the period during insertion of the femoral component. In some previous studies, a low dose of heparin administered intraoperatively was shown to suppress the formation of fibrin.

OBJECTIVE:

The present study was performed to evaluate the influence of intraoperative heparin administration on the D-dimer level and on the prevention of pulmonary embolism after total hip arthroplasty.

MATERIAL/METHODS:

A total of 22 and 26 consecutive patients respectively underwent total hip arthroplasty with and without intraoperative administration of unfractionated heparin. Postoperatively, all patients wore knee-high elastic stockings and were fitted with calf-to-thigh intermittent pneumatic compression devices. Active ankle flexion and extension exercises were commenced as soon as motor function recovered. None of the 48 patients received prophylactic anticoagulants postoperatively.

RESULTS:

There was a significant difference of the mean D-dimer level on the 1st day between the patients with and without intraoperative administration of heparin (8.9 +/- 6.6 vs. 15.7 +/- 12.7, P < 0.05). Although there were no patients with symptomatic deep venous thrombosis and pulmonary embolism, asymptomatic pulmonary embolism was detected by pulmonary perfusion scintigraphy in three patients who did not receive intraoperative heparin. The operative blood loss and postoperative drainage were similar in both groups and no bleeding complications were observed. In conclusion, we recommend a safe and inexpensive regimen comprising 1,000 U of intravenous unfractionated heparin intraoperatively, postoperative pneumatic compression, and early active mobilization for prevention of thoromboembolic complications after total hip arthroplasty.

• Authors: Katsuhiko Maezawa, Masahiko Nozawa, Kentaro Aritomi, Mitsuaki Kubota, Katsuo Shitoto, Hisashi Kurosawa
• Journal: Archives of orthopaedic and trauma surgery (Arch Orthop Trauma Surg) Vol. 128 Issue 1 Pg. 37-40 (Jan 2008) ISSN: 0936-8051 [Print] Germany
• PMID: 17522875 (Publication Type: Journal Article)

Chemical References

• Fibrin Fibrinogen Degradation Products
• fibrin fragment D
• Heparin

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Heparin (administration & dosage)
• Humans
• Intraoperative Period
• Male
• Middle Aged
• Osteoarthritis, Hip (surgery)
• Postoperative Complications (epidemiology)
• Postoperative Period
• Pulmonary Embolism (epidemiology, prevention & control)
• Venous Thrombosis (prevention & control)