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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2000 April;51(2):73-8
Comparison of three drugs for antithrombotic prophylaxis in major orthopedic surgery
Mandò M., Margiacchi G. P., Alioto R., Ferri L., Bernardoni F., Alberti G., Teti A., De Simone L., Bardelli M.
Background. The incidence of deep venous thrombosis (DVT) is still high in general surgery and the risk increases in artificial limb surgery. DVT and pulmonary thromboembolism (PTE) represent the main causes of morbidity and mortality in hospitalized patients. Three drugs with different sites of action are compared. Low molecular weight heparin (LMWH), Indobufene (INDO), defined molecular weight heparitin sulfate (DMWH) in order to identify the best drug to guarantee good DVT prevention with minimum risk of intra- and postoperative hemorrhage.
Methods. 150 patients with a mean age of 64 years, subdivided into 3 groups of 50 patients, undergoing hip and knee replacement orthopedic surgery. Indobufene group: 200 mg p.o. 48 h preoperatively. Heparitin sulfate group: 40 mg p.o. 48 h preoperatively. LMWH group: 0.4 ml s.c. 12 h prior to surgery. Treatment continued at the same doses during the postoperative period and for 30 days after discharge. All patients underwent subarachnoid anesthesia and hematochemical, clinical and instrumental parameters were checked at set intervals. Postoperative bleeding was also evaluated, together with the onset of hematoma and the need for transfusions. All patients received physiokinesiotherapy and some also underwent preoperative hemodilution if necessary.
Results. The most frequent complications were hematomas and DVT without PTE. The highest incidence was found in the LMWH and DMWH groups. Both of these groups also showed the highest levels of postoperative blood transfusions. Blood coagulation tests were unchanged in all three groups.
Conclusions. The prevention of thromboembolic disease in major orthopedic surgery calls for a multifactorial approach that includes the association of rheological, physiotherapeutic, anesthesiological and pharmacological measures. While there is a clear-cut consensus on the former, the best type of pharmacological prophylaxis is still open to debate. Of the three drugs examined here, Indobufene appears to produce a better cost-benefit ratio compared to the other two.