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There is a high incidence of deep vein thrombosis (DVT) and pulmonary embolism (PTE) amongst patients undergoing surgery for hip replacement. We have assessed the use of ancrod (Arvin), a de- fibrinating enzyme in the prophylaxis of DVT.  In a randomised double-blind controlled trial 35 patients received daily subcutaneous injections of ancrod after operation for hip replacement and 38 patients received saline injections. DVT was detected by bilateral ascending venography (68 patients) or post-mortem (1 patient) 7-19 days after surgery. The frequency of major femoral DVT (&gt; 5 cm long) was significantly reduced from 18 thrombi in the limbs of the placebo group to 5 in the ancrod group ( p&lt;0.05). Major bilateral femoral DVT were similarly reduced from 7 to 1 patients by treatment with ancrod.  The overall frequency of all thrombi, including calf DVT, was however not significantly different between the groups. 5 patients had evidence of PTE (3 placebo, 2 ancrod). 6 patients within the ancrod group had evidence of increased wound bleeding, compared with one placebo patient, but in only one patient was this considered severe enough to require cessation of ancrod injections. As the majority of PTE perhaps arise from large femoral thrombi it would seem that ancrod prophylaxis, by reducing thrombus size, could aid the reduction of PTE in this group of patients.

An Assessment Of Subcutaneous Ancrod In Prevention Of Deep Vein Thrombosis After Surgery For Hip Replacement