Eriksson B I, Zachrisson B E, Teger-Nilsson A C, Risberg B
Department of Orthopaedics, Ostra sjukhuset, Göteborg, Sweden.
Br J Surg. 1988 Nov;75(11):1053-7. doi: 10.1002/bjs.1800751104.
In a randomized prospective trial, the efficacy of low molecular weight heparin (LMWH) (Fragmin) and dextran 70 (Macrodex) in preventing deep vein thrombosis (DVT) in the legs was evaluated in 98 consecutive patients undergoing elective total hip replacement. The patients were randomly allocated to receive either 2500 anti-factor Xa units LMWH twice daily for 7 days, with the first dose given 2 h before surgery; or 500 ml dextran 70 twice during the day of operation, followed by a single infusion of 500 ml on the first and again on the third postoperative day. DVT was assessed by 125I-fibrinogen test for 2 weeks postoperatively, a positive test being followed by phlebography. DVT developed in 22 (45 per cent) of 49 patients receiving dextran 70 and in 10 (20 per cent) of 49 patients in the LMWH group (P less than 0.01). LMWH was thus statistically significantly better than dextran 70 in preventing DVT in the legs. It was not firmly established whether this benefit was also valid in the high ileofemoral region. Two patients with non-fatal pulmonary embolism were found in each group. Per- and postoperative blood loss and blood transfusion requirements were significantly lower in the LMWH group.
在一项随机前瞻性试验中，对98例连续接受择期全髋关节置换术的患者，评估了低分子量肝素（LMWH）（速碧林）和右旋糖酐70（麦道可兰）预防腿部深静脉血栓形成（DVT）的疗效。患者被随机分配，一组接受2500抗Xa因子单位的低分子量肝素，每日两次，共7天，首剂在手术前2小时给予；另一组在手术当天给予500ml右旋糖酐70两次，然后在术后第一天和第三天各单次输注500ml。术后2周通过125I - 纤维蛋白原试验评估DVT，试验阳性后进行静脉造影。接受右旋糖酐70的49例患者中有22例（45%）发生DVT，低分子量肝素组的49例患者中有10例（20%）发生DVT（P<0.01）。因此，在预防腿部DVT方面，低分子量肝素在统计学上显著优于右旋糖酐70。在高位髂股区域这种益处是否同样有效尚未明确确定。每组均发现2例非致命性肺栓塞患者。低分子量肝素组围手术期失血量和输血需求量显著更低。
