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15 March 1994 | Volume 120 Issue 6 | Page 523
We did not discuss management of hypercoagulable events after hip and knee replacement because not enough data are available to determine preferable pre- and postoperative approach. However, accumulating evidence suggests that low-molecular-weight heparin may represent a useful new therapeutic strategy for postoperative prophylaxis. In recent trials [1-3], low-molecular-weight heparin has led to a risk reduction of between 70% and 80% with no increase in clinically important bleeding compared with placebo. This therapy seems as effective as dose-adjusted heparin and warfarin in hip replacement and more effective than warfarin in knee replacement [4]. Anti-inflammatory agents combined with antithrombotic therapy may favorably alter the endothelial cell thrombogenic phenotype; however, this approach must await appropriate clinical trials.
1. Leclerc JR, Geerts WH, Desjardins L, Jobin F, Laroche F, Delorme F, et al. Prevention of deep vein thrombosis after major knee surgery—a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost. 1992; 67:417-23.
2. Turpie AG, Levine MN, Hirsch J, Carter CJ, Jay RM, Powers PJ, et al. A randomized controlled trial of a low molecular weight heparin (enoxaparin) to prevent deep vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986; 315:925-9.
3. Hoek J, Nurmohamed MT, ten Cate H, ten Cate JW, Buller HR. Prevention of deep vein thrombosis (DVT) following total hip replacement by a low molecular weight heparinoid (ORG 10172) (Abstract). Thromb Haemost. 1989; 62:520.
4. Hirsch J, Levine MN. Low molecular weight heparin. Blood. 1992; 79:1-17. About Letters
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Hypercoagulability after Hip and Knee Replacement
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The New York Hospital-Cornell Medical Center; New York, NY 10021
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