GIVING BOTH ENOXAPARIN AND DEXTRAN INCREASES THE NEED FOR TRANSFUSIONIN REVISION HIP-ARTHROPLASTY

Objective: To find out if the need for transfusion was increased by vo lume substitution with dextran 70 in patients receiving prophylaxis ag ainst thrombosis with low molecular weight heparin. Design: Open rando mised controlled trial. Setting: University hospital, Sweden. Subjects : 40 patients undergoing revision hip arthroplasty. Interventions: Eno xaparin 40 mg was given daily. Intraoperative normovolaemia was mainta ined with albumin (n = 20) or dextran 70 (n = 20). Intraoperative auto transfusion was used. Packed cell volume was kept above 0.29, if neces sary with homologous blood. Main outcome measures: External blood loss , red cell balance. Results: Dextran patients received 0.64 (0.2) g/kg of dextran (mean (SD)) and required more (p < 0.05) homologous blood (3.8 (2.4) units) than those receiving albumin (2.3 (1.6) units). The initial and final packed cell volumes were similar (0.40 and 0.32 comp ared with 0.41 and 0.32, respectively). The calculated loss of red cel ls was larger in the dextran group (1401 (511) compared with 1077 (374 ); p < 0.05). Conclusion: The combination of enoxaparin and dextran ap preciably increased the need for transfusion compared with enoxaparin alone.