Colwell Clifford W, Hardwick Mary E
Shiley Center for Orthopaedic Research and Education, Scripps Clinic, La Jolla, CA 92037, USA.
Clin Orthop Relat Res. 2006 Nov;452:181-5. doi: 10.1097/01.blo.0000238826.63648.c5.
Low-molecular-weight heparin has been studied extensively in total knee arthroplasty (TKA) and provides highly effective and safe prophylaxis against deep venous thrombosis (DVT). Low-molecular-weight heparin received the highest rating (A1) in the American College of Chest Physicians recommendations for DVT prophylaxis after elective TKA. Prevalence of DVT with low-molecular-weight heparin prophylaxis was 33% in TKA data pooled from six randomized studies, with a proximal DVT rate of 7.1%. A metaanalysis reported a 2.4% rate of major bleeding with low-molecular-weight heparin. Low-molecular-weight heparin, given by subcutaneous injection, can be started before surgery or after surgery. A synthetic pentasaccharide (fondaparinux), which received an A1 rating in the American College of Chest Physicians recommendations, also is available. As with all treatments, the benefit must be considered against the risk when using these anticoagulants.
低分子量肝素已在全膝关节置换术（TKA）中得到广泛研究，并为预防深静脉血栓形成（DVT）提供了高效且安全的方法。在美国胸科医师学会关于择期全膝关节置换术后深静脉血栓形成预防的建议中，低分子量肝素获得了最高评级（A1）。在六项随机研究汇总的全膝关节置换术数据中，采用低分子量肝素预防深静脉血栓形成的发生率为33%，近端深静脉血栓形成率为7.1%。一项荟萃分析报告称，低分子量肝素导致大出血的发生率为2.4%。低分子量肝素通过皮下注射给药，可在手术前或手术后开始使用。一种合成五糖（磺达肝癸钠）在美国胸科医师学会的建议中也获得了A1评级，同样可供使用。与所有治疗方法一样，在使用这些抗凝剂时，必须权衡益处与风险。
