Intraoperative heparin in addition to postoperative low-molecular-weight heparin for thromboprophylaxis in total knee replacement

The administration of heparin during operation has been reported to enhance the efficacy of thromboprophylaxis in patients undergoing total hip replac ement. We have performed a small pilot study in which intraoperative doses of heparin were given in addition to the usual postoperative thromboprophyl axis with enoxaparin in 32 patients undergoing total knee replacement. The primary endpoint was deep-vein thrombosis (DVT) as demonstrated by bilatera l venography on 6 +/- 2 days after operation, Sixteen patients developed DVT; in two the thrombosis was proximal as well as distal and in one the occurrence was bilateral. There was one major haem orrhage. These results are similar to those obtained with the use of postop erative thromboprophylaxis with enoxaparin alone. They do not provide suppo rt for the initiation of a larger randomised trial of this approach to mana gement.