Francis C W, Pellegrini V D, Harris C M, Marder V J
Department of Medicine, University of Rochester School of Medicine and Dentistry, New York.
Am J Med. 1989 Sep 11;87(3B):61S-66S. doi: 10.1016/0002-9343(89)80534-0.
The use of antithrombin III (ATIII) replacement in combination with low-dose heparin therapy in prevention of postoperative venous thrombosis in patients following total hip replacement or total knee replacement was evaluated. A randomized prospective venographically controlled trial in hip replacement compared treatment with dextran 40 with a regimen of ATIII (1,500 units preoperatively and 1,000 units daily for five days) and low-dose heparin. Patients receiving ATIII/heparin had significantly higher postoperative ATIII concentrations than dextran-treated patients and also had a low incidence of venous thromboembolic disease (7 percent). The ATIII/heparin regimen was well tolerated with no increase in bleeding or significant prolongation of the activated partial thromboplastin time. Two cohorts of patients undergoing total knee replacement were studied using different doses of ATIII in combination with heparin. An initial 10 patients were treated with the same ATIII dose used for patients undergoing total hip replacement, with a 50 percent incidence of venous thrombosis. A second group of 11 patients was treated with twice the dose of ATIII, and an incidence of venous thrombosis of 27 percent was found. The higher ATIII dose resulted in significantly higher ATIII concentrations and maintained the postoperative ATIII concentration above normal. Among patients receiving prophylaxis with either warfarin. dextran, or ATIII/heparin, no clear association was found between reduced ATIII concentrations and occurrence of venous thrombosis. It is concluded that ATIII replacement following total hip or knee replacement corrects the postoperative ATIII deficiency and that the combination of ATIII and low-dose heparin is an effective prophylactic regimen following total hip replacement.
评估了抗凝血酶III（ATIII）替代疗法联合小剂量肝素治疗在预防全髋关节置换术或全膝关节置换术患者术后静脉血栓形成中的应用。一项关于髋关节置换术的随机前瞻性静脉造影对照试验，比较了右旋糖酐40与ATIII方案（术前1500单位，术后连续五天每日1000单位）及小剂量肝素的治疗效果。接受ATIII/肝素治疗的患者术后ATIII浓度显著高于接受右旋糖酐治疗的患者，静脉血栓栓塞性疾病的发生率也较低（7%）。ATIII/肝素方案耐受性良好，出血无增加，活化部分凝血活酶时间也无显著延长。对两组接受全膝关节置换术的患者使用不同剂量的ATIII联合肝素进行了研究。最初的10名患者接受了与全髋关节置换术患者相同剂量的ATIII治疗，静脉血栓形成的发生率为50%。第二组11名患者接受了两倍剂量的ATIII治疗，静脉血栓形成的发生率为27%。较高剂量的ATIII导致ATIII浓度显著升高，并使术后ATIII浓度维持在正常水平以上。在接受华法林、右旋糖酐或ATIII/肝素预防的患者中，未发现ATIII浓度降低与静脉血栓形成之间存在明确关联。得出的结论是，全髋关节或膝关节置换术后补充ATIII可纠正术后ATIII缺乏，并且ATIII与小剂量肝素联合是全髋关节置换术后有效的预防方案。
