Taberner D A, Poller L, Thomson J M, Lemon G, Weighill F J
UK Reference Laboratory for Anticoagulant Reagents and Control, Withington Hospital, Manchester.
Br J Surg. 1989 Sep;76(9):933-5. doi: 10.1002/bjs.1800760920.
A randomized study of adjusted versus fixed low dose heparin prophylaxis has been conducted in 100 patients undergoing surgery for hip replacement or fractured neck of femur. The two types of patients were randomized independently into the adjusted and fixed dose regimens. Patients in the adjusted group were controlled by an activated partial thromboplastin time method particularly responsive to the anticoagulant effect of heparin. The aim was to maintain the peak value just above the upper limit of the normal range. Adjustment of dosage began 24 h after surgery in the replacement group and 24 h after admission in the fracture group. Significant improvement in protection against postoperative deep vein thrombosis, assessed by venography, was observed in the adjusted group undergoing hip replacement (P = 0.013) and overall in both groups (P = 0.017) compared with a conventional fixed dose subcutaneous regimen (calcium heparin 5000 units, 8-hourly). In most instances, adjustment resulted in increased heparin dosage but this was not associated with any evidence of excessive bleeding.
对100例接受髋关节置换术或股骨颈骨折手术的患者进行了一项关于调整剂量与固定低剂量肝素预防的随机研究。这两类患者被独立随机分为调整剂量方案组和固定剂量方案组。调整剂量组的患者通过活化部分凝血活酶时间方法进行监测，该方法对肝素的抗凝作用特别敏感。目标是将峰值维持在正常范围上限之上。置换组在术后24小时开始调整剂量，骨折组在入院后24小时开始调整剂量。与传统的固定剂量皮下注射方案（肝素钙5000单位，每8小时一次）相比，通过静脉造影评估，在接受髋关节置换术的调整剂量组（P = 0.013）以及两组总体（P = 0.017）中，预防术后深静脉血栓形成有显著改善。在大多数情况下，调整导致肝素剂量增加，但未发现任何出血过多的迹象。
