What question did this study set out to answer?

To determine whether administering low-molecular-weight heparin immediately before or early after elective hip arthroplasty reduces venous thrombosis compared to standard postoperative warfarin.

July 24, 2000Archives of Internal Medicine

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

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Why the study?

Does subcutaneous dalteparin given immediately before or early after surgery reduce deep vein thrombosis in patients undergoing elective hip arthroplasty compared to postoperative warfarin?

Population

1472 patients undergoing elective hip arthroplasties

Comparison

Subcutaneous dalteparin sodium given once daily… vs Postoperative warfarin sodium

Design

RCT, randomized, double-blind

Follow-up

mean, 5.7 days

Authors

RHRussell D. HullUniversity of Calgary

Discussion

Member takes

Implication

Pre- or postoperative dalteparin reduces DVT versus warfarin after hip arthroplasty; reinforces LMWH superiority for orthopedic VTE prophylaxis.

Key Points

To determine whether administering low-molecular-weight heparin immediately before or early after elective hip arthroplasty reduces venous thrombosis compared to standard postoperative warfarin.
Conducted a randomized, double-blind clinical trial in 1,472 patients undergoing elective hip arthroplasties.
Assigned patients to receive subcutaneous dalteparin once daily immediately preoperative, dalteparin early postoperative, or postoperative oral warfarin.
Evaluated deep vein thrombosis using contrast venography performed at a mean of 5.7 days after surgery.
Total deep vein thrombosis occurred in 10.7% (36/337, P < .001) of preoperative dalteparin patients and 13.1% (44/336, P < .001) of postoperative dalteparin patients compared to 24.0% (81/338) with warfarin.
Proximal deep vein thrombosis developed in 0.8% (3/354, P = .04) of preoperative dalteparin and 0.8% (3/358, P = .03) of postoperative dalteparin patients versus 3.0% (11/363) with warfarin, yielding 45% to 72% relative risk reductions.
Symptomatic clots were fewer with preoperative dalteparin (1.5% vs 4.4%, P = .02), though surgical site major bleeding increased compared with warfarin (P = .01), while postoperative dalteparin had similar bleeding rates to warfarin.

Structured PICO

Does subcutaneous dalteparin given immediately before or early after surgery reduce deep vein thrombosis in patients undergoing elective hip arthroplasty compared to postoperative warfarin?

Population

1472 patients undergoing elective hip arthroplasties

Intervention

Subcutaneous dalteparin sodium given once daily immediately before or early after surgery

Comparator

Postoperative warfarin sodium

Outcome

Deep vein thrombosis detected using contrast venography performed after surgery (mean, 5.7 days)surrogate

Dalteparin initiated in close proximity to surgery (pre- or post-operatively) significantly reduces the risk of deep vein thrombosis compared to warfarin in patients undergoing elective hip arthroplasty, though preoperative initiation increases major surgical site bleeding.

Cite This Study

Russell D. Hull (2000) studied this question.

synapsesocial.com/papers/6a73eabac973d0bd5a69fa23 https://doi.org/10.1001/archinte.160.14.2199

Topics

Anticoagulation in AF

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Implication

Pre- or postoperative dalteparin reduces DVT versus warfarin after hip arthroplasty; reinforces LMWH superiority for orthopedic VTE prophylaxis.

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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