Results of adjusted-dose heparin for thromboembolism prophylaxis in knee replacement compared to those found for its use in hip fracture surgery and elective hip replacement.

The purpose of this study was to compare the results of adjusted-dose heparin (ADH) in the prevention of thromboembolism in knee replacement with those obtained for its use hip fracture surgery and elective hip replacement. Ultrasound was used to diagnose deep vein thrombosis (DVT) and ventilation/perfusion (V/Q) scan to diagnose pulmonary embolus (PE). Analysis of 438 operations was available. DVT was present after 9.7% of knee replacements, 7.2% of hip fracture operations and 6.8% of elective hip replacements. PE occurred in 1.2% of knee replacements, 0.9% of hip fracture operations and 2.5% of elective hip replacements. Proximal DVT occurred in 4.2% of knee replacements, 3.6% of hip fracture operations and 4.3% of elective hip replacements. Complications of heparin occurred in 4.6% of patients. Our ADH protocol was equally effective in prophylaxis against thromboembolism in knee replacement, hip fracture surgery and elective hip replacement. Direct comparison with other methods should not be done because ultrasound was used to screen for DVT.