Rader C P, Kramer C, König A, Hendrich C, Eulert J
Department, University of Würzburg, Germany.
J Arthroplasty. 1998 Feb;13(2):180-5. doi: 10.1016/s0883-5403(98)90096-1.
Thromboprophylaxis with heparins after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is well established. The aim of this study was to compare low-molecular-weight heparin (enoxaparin) with partial thromboplastin time (PTT)-adjusted, unfractionated heparin (heparin sodium). In a prospective study of THA and TKA 246 patients, physical examination and compression and duplex ultrasound were performed 1 day before and 7 and 14 days after surgery. One hundred thirty patients received 40 mg enoxaparin subcutaneously once per day. One hundred sixteen patients received 5,000 IU heparin sodium subcutaneously 3 times daily. As the PTT did not reach 40 seconds, the heparin sodium dosage was increased to 7,500 IU 3 times daily. The overall thrombosis rate was 4% (n = 10). In the enoxaparin group, the rate was 2.9% of the 70 THAs and 10% of the 60 TKAs. Thrombosis also occurred in the group that received heparin sodium: 1.8% of the THAs and 1.7% of the TKAs. For TKA, the difference between the 2 heparin groups was statistically significant. In the thromboprophylaxis of TKA, PTT-adjusted unfractionated heparins are superior to fixed doses of low-molecular-weight heparins.
全髋关节置换术（THA）和全膝关节置换术（TKA）后使用肝素进行血栓预防已得到充分证实。本研究的目的是比较低分子量肝素（依诺肝素）与部分凝血活酶时间（PTT）调整的普通肝素（肝素钠）。在一项对246例THA和TKA患者的前瞻性研究中，在手术前1天以及手术后7天和14天进行体格检查、压迫和双功超声检查。130例患者每天皮下注射一次40mg依诺肝素。116例患者每天皮下注射3次5000IU肝素钠。由于PTT未达到40秒，肝素钠剂量增加至每天3次7500IU。总体血栓形成率为4%（n = 10）。在依诺肝素组中，70例THA的发生率为2.9%，60例TKA的发生率为10%。接受肝素钠治疗的组也发生了血栓形成：THA为1.8%，TKA为1.7%。对于TKA，两个肝素组之间的差异具有统计学意义。在TKA的血栓预防中，PTT调整的普通肝素优于固定剂量的低分子量肝素。
