[Preoperative autologous blood collection under erythropoietin stimulation. Preliminary results in patient selection, erythropoietin dosage and administration]. / Präoperative autologe Blutkollektion unter Erythropoietinstimulation. Vorläufige Ergebnisse in Patientenauswahl, Erythropoietin-Dosis und Administration.

In a randomised study we have evaluated the influence of erythropoietin (EPO) on the yield of autologous blood in elective surgery (total hip replacement). The study was performed placebo controlled in 82 patients: 25 patients received 200 IE EPO/kg 2 x/week i.v. over 3 weeks (group C), 30 patients 100 IE EPO in the same schedule (group B), and 27 patients received placebo (group A). All patients were treated with 3 x 250 mg Fe-sulfate p.o. during the study time. The number of collected blood conserves was not significantly different in these groups (5.4 in group C, 5.06 in group B, 4.8 in group A), but there was a significant difference in patients with a diminished hemoglobin (Hb < 14 g/dl): 5.2 in group C, 4.9 in group B, and 3.6 in group A. Patients with a normal hemoglobin level showed a significantly higher preoperative hemoglobin in group C against group A. We conclude that the application of EPO is suggestive in patients with a diminished hemoglobin, but also in patients with normal hemoglobin the blood picture at the time of surgery is higher in EPO treated patients.

Thromboembolic prophylaxis in total hip replacement: a comparison between the low molecular weight heparinoid Lomoparan and heparin-dihydroergotamine.

In a prospective, randomized, assessor-blind multicentre study two antithrombotic subcutaneous regimens were compared in patients undergoing total hip replacement. Group 1 (154 patients) received 750 anti-Xa units of a new low molecular weight heparinoid (Lomoparan) subcutaneously twice a day and group 2 (155 patients) received 5000 units heparin and 0.5 mg dihydroergotamine (heparin-DHE 5000) twice a day. The incidence of deep vein thrombosis, assessed by routine bilateral venography on day 10 (+/- 1), was 17 and 32 per cent in groups 1 and 2 respectively (risk reduction 47 per cent; P = 0.007). One patient in each group developed a symptomatic pulmonary embolism confirmed by lung scanning. Major bleeding complications occurred in one patient in each group and no significant difference was observed between the two groups with respect to minor bleeding complications. Subcutaneous Lomoparan appears to be as safe as heparin-DHE 5000 at the above doses with regard to bleeding complications, and is more efficacious with respect to venous thrombosis.