Schwarz B, Mittelmeier H
Orthopädische Universitätsklinik und -Poliklinik Homburg/Saar.
Aktuelle Traumatol. 1988 Oct;18(5):226-32.
This is a report on almost 10 years of experience with heparin prophylaxis in orthopaedic surgery, especially on the changeover from the high molecular heparin dihydergot used previously, to the low molecular heparin dihydergot (Embolex) while changing over at the same time from the previously well-tried and successful postoperative initiation of treatment to preoperative start of prophylaxis. Compared with the period before prophylaxis (1965-1977) with 24 fatal pulmonary embolisms, no fatal pulmonary embolisms have occurred in our hospital since prophylaxis was introduced (1978). Changeover to low molecular heparin with only one instead of three injections daily was fundamentally welcomed although preoperative onset of prophylaxis involved a considerable rise in afterbleeding complications. Hence we recently adopted the procedure of conducting prophylaxis with low molecular heparin (as was done previously with success using high molecular heparin) postoperatively; this resulted in a dramatic reduction of bleeding complications while protection against thrombosis is obviously clinically satisfactory. Postoperative initiation of prophylaxis is therefore recommended in case of major orthopaedic surgery.
这是一份关于骨科手术中肝素预防治疗近10年经验的报告，特别是关于从先前使用的高分子肝素双氢麦角碱，转换为低分子肝素双氢麦角碱（栓复欣），同时从先前经过充分试验且成功的术后开始治疗，转变为术前开始预防。与预防治疗前的时期（1965 - 1977年）相比，当时有24例致命性肺栓塞，自引入预防治疗（1978年）以来，我院未发生致命性肺栓塞。尽管术前开始预防导致术后出血并发症显著增加，但转为每日仅注射一次而非三次的低分子肝素在根本上是受欢迎的。因此，我们最近采用了术后用低分子肝素进行预防的方法（此前使用高分子肝素成功做到了这一点）；这导致出血并发症大幅减少，同时预防血栓形成在临床上显然令人满意。因此，对于大型骨科手术，建议术后开始预防。
