Comparison of low-molecular-weight heparins in thromboprophylaxis of major orthopaedic surgery - Randomized, prospective pilot study

Abstract

Aim - To compare the clinical effectiveness of the two most commonly used LMWHs, dalteparin (DALT) and enoxaparin (ENOX), in thromboprophylaxis of elective total hip replacement (THR) or total knee replacement (TKR). Material and methods - To the prospective, randomized study were included 66 adult patients qualified to undergo THR or TKR (age 63 ± 12 years, 44 women). The patients were randomized to daily in-hospital subcutaneous prophylaxis with 5,000 I.U. of DALT or 40 mg of enoxaparin. Clinical and laboratory data were collected before surgery, and on 1st and 5th days after surgery. Results - Thirty-four patients were randomized to prophylaxis with ENOX and 32 with DALT. The groups did not differ significantly in age, sex, creatinine and most of the laboratory parameters. The compared groups had similar surgical parameters, but more patients in the ENOX group received red blood cell infusion (17(50%) vs 8(25%); p < 0.05). The Lee.White coagulation time mildly decreased in ENOX and DALT following the surgery (p = ns). There was a shortening of Duke's bleeding time in DALT after the surgery and it became significantly quicker than that in ENOX on Day 5 (p = 0.03). Conclusion - The observed difference in Duke's bleeding time and exceeding blood loss during the surgery on the enoxaparin demands confirmation, as it can be important information for clinical management.