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Intraoperative heparin in addition to postoperative low-molecular-weight heparin for thromboprophylaxis in total knee replacement

Department of Medicine

D. B. Russell, MD, FRCP C, Professor

Departments of Radiology and Diagnostic Imaging, and Anatomy and Cell Biology

D. W. C. Johnston, MD, FRCS C, Clinical Professor

Department of Orthopaedic Surgery

P. A. Donahue, RN, BScN, MN, Research Co-ordinator

Division of Haematology, Department of Medicine, 2E3.32 Walter MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2R7.

Correspondence should be sent to Professor M. J. Mant.

The administration of heparin during operation has been reported to enhance the efficacy of thromboprophylaxis in patients undergoing total hip replacement. We have performed a small pilot study in which intraoperative doses of heparin were given in addition to the usual postoperative thromboprophylaxis with enoxaparin in 32 patients undergoing total knee replacement. The primary endpoint was deep-vein thrombosis (DVT) as demonstrated by bilateral venography on 6 ± 2 days after operation.

Sixteen patients developed DVT; in two the thrombosis was proximal as well as distal and in one the occurrence was bilateral. There was one major haemorrhage. These results are similar to those obtained with the use of postoperative thromboprophylaxis with enoxaparin alone. They do not provide support for the initiation of a larger randomised trial of this approach to management.