Changes of D-dimer after total hip arthroplasty in patients with and without intraoperative heparin |
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Authors: | Katsuhiko Maezawa Masahiko Nozawa Kentaro Aritomi Mitsuaki Kubota Katsuo Shitoto Hisashi Kurosawa |
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Affiliation: | (1) Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku Tokyo, 113-8421, Japan |
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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. |
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