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The prophylactic effect of low dose heparin on postoperative thrombosis in general surgery is well established. Dextran 70 has been shown to reduce the frequency of fatal pulmonary embolism. The effect of these prophylactic methods in-hip surgery is debated. The aim of this study was to compare dextran 70, low dose heparin and no treatment in post-traumatic and elective hip surgery. The groups were separately randomized to either prophylaxis. In patients with hip fracture (75 patients) thrombosis was diagnosed with 125I-fibrinogen test. The same diagnostic method was used after elective hip arthroplasty according to Brunswik (96 patients). In the latter group screening for pulmonary embolism was made one week postoperatively with perfusion scintigraphy (Tc-labelled macroaggregated albumin) and x-ray; the diagnosis being based on the combination of a perfusion defect and normal x-ray. The frequency of thrombosis in patients with hip fracture was 67% in the control group, 67% in the low dose heparin group and 40% in the dextran 70 group. The corresponding frequencies for patients undergoing elective hip surgery were 50, 26 and 55%. Pulmonary embolism was seen in 38, 24 and 24% respectively (one fatal embolism in the control group). From this study it can be concluded that only dextran 70 lowers the frequency of thrombosis after hip fracture. Low dose heparin diminishes the frequency of thrombosis in elective hip surgery whereas the two prophylactic methods are equally effective in prophylaxis of pulmonary embolism.

Prophylaxis of Thromboembolic Complications in HIP Surgery - A Controlled Trial with low Dose Heparin and Dextran 70