[Comparison between low-molecular and unfractionated heparin in the prevention of thrombosis in patients with total endoprosthetic replacement of hip and knee joint]. / Vergleich zwischen niedermolekularen und unfraktionierten Heparinen (PTT gesteuert) in der Thromboseprophylaxe bei Patienten mit totalendoprothetischem Ersatz von Hüft- und Kniegelenk.

ABSTRACT

PURPOSE: Thrombosis-prophylaxies with heparins after total hip arthroplasty (THP) and total knee arthroplasty (TKA) is well accepted. The aim of this study was to compare the low molecular weight heparin (Enoxaparin) with PTT adjusted unfractionated heparin (Na-heparin). METHODS: In a prospective study of 226 patients after THA and TKA, we performed physical examination and ultrasound in compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. 120 patients received Enoxaparin 1 x 40 mg per day in fixed dosage. 106 patients received Na-heparin 3 x 5000 IE. Since PTT did not reach 40 seconds, Na-heparin dosage was increased to 3 x 7500 IE. RESULTS: The overall thrombosis rate was 4% (n = 9), in the Enoxaparin group 2.9% for the 70 THA and 10% for the 50 TKA. Thrombosis occurred in the group of unfractionated heparin (PTT adjusted) in 1.8% after THA and in 2% after TKA. In TKA, there is statistical difference between the two heparin groups. CONCLUSION: In the thrombosis prophylaxis of TKA, PTT adjusted unfractionated heparin is superior to low molecular weight heparin in fixed dosage.