LOW-MOLECULAR-WEIGHT HEPARIN (ENOXAPARIN) COMPARED WITH UNFRACTIONATED HEPARIN IN PROPHYLAXIS OF DEEP VENOUS THROMBOSIS AND PULMONARY-EMBOLISM IN PATIENTS UNDERGOING HIP-REPLACEMENT

Prophylactic efficacy and safety of a low molecular weight heparin (LM WH) and those of conventional unfractionated heparin (UH) were investi gated in a randomized study. Totally, 167 consecutive patients undergo ing total hip replacement were allocated to two groups. Patients in th e LMWH-group (n = 83) received a fixed dose of enoxaparin 40 mg once d aily, starting 12 hours peroperatively and continuing for 10 days. Pat ients in the UH-group (n = 84) received UH 5000 IU twice a day subcuta neously (sc), starting two hours before operation and continuing for 1 0 days. Deep venous thrombosis (DVT) was diagnosed by bilateral ultras onography and confirmed by venography. Proximal DVTs were observed in four patients of UH-group (4.8 %) and in one of LMWH-group (1.2 %, P > 0.05). There was only one pulmonary embolism (PE) in a patient belong ing to UH-group (1.2 %). Low rates of thromboembolic events could be e xplained, in addition to heparin prophylaxis, also by early mobilizati on and regional anaesthesia. Local tolerance (size of haematoma), bloo d loss and transfusion requirements during the operation and the posto perative period did not show differences between the two study groups. The results of our study indicate that enoxaparin once daily is an ef fective and safe form of DVT prophylaxis in patients undergoing electi ve hip replacement.