Original Article
Low-Molecular-Weight Heparin (Enoxaparin) as Prophylaxis against Venous Thromboembolism after Total Hip Replacement
N Engl J Med 1996; 335:696-700September 5, 1996
- Abstract
Background
The risk of venous thromboembolism in patients undergoing total hip replacement is known to be high. However, the optimal duration of prophylaxis with anticoagulant agents after this procedure is unknown. We sought to determine whether one month of anticoagulant therapy with the low-molecular-weight heparin enoxaparin is more effective than enoxaparin therapy given only during the hospitalization for surgery.
Methods
Two hundred sixty-two patients undergoing total hip replacement received enoxaparin during their hospitalizations (average stay, 10 to 11 days). They were then randomly assigned to receive enoxaparin or placebo (131 patients each). Blinded outpatient therapy (or placebo) was continued long enough that the total treatment period, inpatient plus outpatient, was one month for each patient. Bilateral ascending phlebography was performed 19 to 23 days after discharge, with deep-vein thrombosis as the primary end point. Distal and proximal thrombosis, pulmonary embolism, and hemorrhage were also recorded, as were deaths.
Results
Venography was adequate in 116 patients in the placebo group and 117 in the enoxaparin group. We observed 43 episodes of deep-vein thrombosis and 2 episodes of pulmonary embolism in the placebo group, but only 21 episodes of deep-vein thrombosis and no episodes of pulmonary embolism in the enoxaparin group (incidence of thromboembolism, 39 percent and 18 percent, respectively; P<0.001). The difference in the incidence of proximal deep-vein thrombosis was also significant (24 percent and 7 percent in the placebo and enoxaparin groups, respectively; P<0.001). Six patients in the enoxaparin group and one patient in the placebo group had hematomas at their injection sites. No patients died or had major complications.
Conclusions
There were significantly fewer venous thromboembolic complications in patients undergoing elective hip replacement when prophylaxis with enoxaparin was given for a total of one month, rather than only during the hospitalization.
Media in This Article
Table 1
Demographic Characteristics and Risk Factors in 262 Patients Who Underwent Total Hip Replacement, According to Study Group.Table 2
Incidence of Thromboembolic Events in the Patients with Adequate Venography, with Odds Ratios and 95 Percent Confidence Intervals (CI).Article Activity
- Article
Without prophylactic anticoagulation, the frequency of deep-vein thrombosis after total hip replacement is high, in the range of 50 to 60 percent.1,2 With various methods of anticoagulant therapy, this frequency can be substantially reduced,3,4 the best option at present being low-molecular-weight heparin,1,2,4-6 which is also cost effective.7-9
In addition to the high risk of deep-vein thrombosis, hip surgery has certain special characteristics. The risk of deep-vein thrombosis is more protracted after hip surgery than after general surgery, when it usually develops during the first few postoperative days.10,11 The surgical technique, which kinks the femoral vein, seems to stimulate proximal deep-vein thrombosis in the leg that is operated on,12,13 whereas calf-vein thrombosis is more likely to develop in either leg. Another result of surgery can be the impairment of venous hemodynamics, which may last several weeks, in the leg that is operated on.14 In a study of patients undergoing general abdominal surgery, Scurr et al.15 found that deep-vein thrombosis continued to be a problem after the patients had left the hospital. During the first month, the condition developed in about 25 percent of those without thrombosis at discharge.
A recent study of patients undergoing total hip arthroplasty showed a 10.5 percent incidence of deep-vein thrombosis during the first six weeks after surgery.16 Thus, the thrombogenic period may be prolonged in some patients, and the risk of fatal pulmonary embolism continues for at least one month after surgery.17,18 In patients with trauma, the risk may last even longer.19-21 For these reasons, the question of providing extended prophylactic anticoagulant therapy has been raised and was said to be of key importance in the European Consensus Statement.22
We therefore attempted to determine whether enoxaparin, a low-molecular-weight heparin, prevented thrombosis better if it was given only during the hospitalization for surgery (according to the usual practice) or if it was continued for a full month postoperatively.
Methods
Study Design
This was a prospective, randomized, double-blind study conducted at a single center. Patients undergoing primary elective hip arthroplasty were included in the study if they were more than 39 years old and weighed more than 60 kg. They were excluded from the study if they had renal insufficiency; hypersensitivity to contrast medium, heparin, or low-molecular-weight heparin; a past or present risk of hemorrhage; endocarditis, severe liver disease, or untreated hypertension; or venous thromboembolism within the preceding three months; if they had received treatment with heparin, low-molecular-weight heparin, oral anticoagulants, or nonsteroidal antiinflammatory drugs within the five days before surgery; or if they had undergone ipsilateral hip surgery within the preceding six months; if they were pregnant or lactating; or if they did not give informed consent.
During the hospitalization (which was scheduled to last 9 days; anticipated range, 7 to 11 days), all the patients received prophylaxis against thrombosis with 40 mg (0.4 ml) of enoxaparin (Klexane, Rhône–Poulenc Rorer) injected subcutaneously into the abdominal wall once daily, with the first dose given the evening before surgery (according to the schedule, 12 hours beforehand; range, 10 to 14). At the end of the hospitalization, the patients were randomly assigned to continue receiving enoxaparin (40 mg once daily) or to receive placebo (0.4 ml of saline) once daily.
The first injection after the hospitalization was given the day after discharge. The post-discharge prophylaxis was given by study nurses who visited the patients daily in their homes. The outpatient prophylaxis was scheduled to last 21 days (range, 19 to 23), or until the time of phlebography. To enter the double-blind phase of the trial, patients could not have undergone a reoperation or have had clinical venous thromboembolism or major hemorrhage. They also had to have received prophylaxis with enoxaparin starting the evening before their surgery, as stated in the protocol.
Hip surgery was performed through a lateral incision, with or without osteotomy, with the patient supine.
Assessment of Outcome
On day 21 (range, 19 to 23) after hospital discharge, the protocol called for bilateral ascending phlebography of the legs to screen for deep-vein thrombosis. During this procedure, the patient was seated with the lower leg in a vertical position. Fifty milliliters of contrast medium (Hexabrix [with 160 mg of iodine per milliliter] or Omnipaque [180 mg of iodine per milliliter]) was injected into a dorsal foot vein. Frontal and lateral films of the lower leg were obtained. The patient was then placed in a supine position, and a tourniquet was applied to the uppermost part of the thigh to occlude the great saphenous vein. An additional 50 ml of contrast medium was injected into the same vein that had been used in the lower leg, and frontal films of the popliteal, femoral, iliac, and inferior caval veins were obtained. With this technique, even bedridden patients who had just undergone surgery could be examined adequately.
When thrombosis was suspected for clinical reasons before the time of the scheduled phlebography, the procedure was performed on an emergency basis. If deep-vein thrombosis was found, no further phlebography was performed. If the study was negative, the planned bilateral phlebography was performed according to protocol.
Each phlebogram was examined by a committee of three radiologists unaware of the patients' group assignments. All the interpretations and classifications were made before the randomization code was broken. Each film was interpreted independently by each radiologist. If there were discrepancies in diagnoses, the committee members discussed the case further and reached a consensus.
A thrombus was considered to be present when there was a filling defect surrounded by contrast medium, or the consistent nonvisualization of a deep vein, caused by increased subfascial pressure or total obliteration. Collateral flow through the superficial leg veins was seen when there was increased subfascial pressure or total obliteration. In the latter case, the tip of the thrombus was often visible. Only thrombi in venous segments located within the deep fascia were considered to be deep-vein thrombi.
The results of phlebography were considered inadequate if the amount of contrast medium injected was too small and the resulting phlebograms were uninterpretable. The thrombi were classified according to whether they occurred in the leg that was operated on or the contralateral leg and according to whether the thrombosis was proximal, distal, or both proximal and distal (involving the whole leg). The border between proximal and distal thromboses was the knee joint. In the case of clinically suspected pulmonary embolism, ventilation–perfusion lung scanning or pulmonary angiography was performed.
Follow-up was performed three months postoperatively to determine the patients' vital status.
Hemorrhagic Complications
The anesthetist estimated the amount of blood lost intraoperatively by examining swabs and suction bottles. The volume of blood drained postoperatively was recorded, as were the transfusion requirements and all instances of postoperative hemorrhage, wound hematoma, and reoperation. Hemorrhages were classified as minor or major. Major hemorrhage was defined as clinically overt bleeding that was associated with a decrease in the hemoglobin level of 2 g per deciliter or more, requiring the transfusion of two or more units of blood products; bleeding that was retroperitoneal or intracranial in location; or bleeding that necessitated reoperation. Hemorrhage that did not meet any of these criteria was classified as minor.
Statistical Analysis
The analysis of thromboembolic events (both deep-vein thrombosis and pulmonary embolism) included 233 patients who had adequate venography (116 in the placebo group and 117 in the enoxaparin group). The analysis of hemorrhagic complications included only the patients who were actually treated. Most of the data were expressed in terms of descriptive statistics or 95 percent confidence intervals. In the analysis of efficacy, two-tailed chi-square tests and odds ratios derived from a logistic-regression analysis were used. In the analysis of safety, two-tailed Fisher's exact tests were used. The study was approved by the ethics committee of the University of Lund, Sweden. All the patients provided witnessed informed consent.
Results
Two hundred eighty-eight patients were enrolled in the study, 262 of whom underwent randomization for outpatient prophylaxis. The results for the hospital period (before randomization) and the period from discharge to the time of phlebography (the double-blind period) are presented separately here.
Hospital Period
During the hospital period, all the patients received prophylaxis with enoxaparin. The patients later assigned to enoxaparin and those later assigned to placebo were well matched with regard to demographic variables, surgical procedures, and variables pertaining to the hospital course after surgery (Table 1Table 1
Demographic Characteristics and Risk Factors in 262 Patients Who Underwent Total Hip Replacement, According to Study Group.). The median time from the preoperative dose of enoxaparin to the start of surgery was 12.3 hours (range, 9.6 to 33.5) in the placebo group and 12.2 hours (range, 9.0 to 15.9) in the enoxaparin group. There was no difference between the groups in the side of the body on which the surgery was performed, the surgical approach (Hardinge or Charnley), the type of prosthesis used (cemented or uncemented), or intraoperative blood loss (median in both groups, 700 ml). In the majority of operations (95 percent), epidural anesthesia was used. The median duration of surgery was 1.9 hours (range, 1.0 to 5.0) in the placebo group and 1.7 hours (range, 1.1 to 5.2) in the enoxaparin group. The amount of blood lost through drainage, the amount given in transfusion, and the decrease in hemoglobin did not differ between the groups. The open-label period lasted 11 days (range, 7 to 12) in the placebo group and 10 days (range, 6 to 11) in the enoxaparin group. Five patients had hemorrhagic complications: three in the enoxaparin group and two in the placebo group. All were due to bleeding from the surgical wound. There were no clinical episodes of thromboembolism during hospitalization.Post-Discharge Period
Of the 288 patients initially enrolled, 262 were randomized, 131 to each study group. Twenty-six patients were not randomized: eight withdrew their consent, the condition of five was deteriorating, four had violations of the study protocol, two had intercurrent events, one died (acute myocardial infarction was suspected, but no autopsy was performed), one was excluded for administrative reasons, and five were not randomized for various other reasons. After randomization, no patients were excluded from the analysis of patients who were actually treated.
Phlebography could not be performed at all in four patients and was performed in only one leg in an additional five. In 20 cases, the phlebography was considered inadequate. The median time from discharge to phlebography was 18 days (range, 1 to 23) in the placebo group and 19 days (range, 1 to 23) in the enoxaparin group.
Thromboembolic Complications
Of the 233 patients who could be evaluated, 66 had deep-vein thrombosis or pulmonary embolism (28 percent). Table 2Table 2
Incidence of Thromboembolic Events in the Patients with Adequate Venography, with Odds Ratios and 95 Percent Confidence Intervals (CI). shows the frequencies of these conditions. The reduction in the frequency of venous thromboembolic disease with enoxaparin treatment was significant, especially in the case of proximal deep-vein thrombosis. There were two pulmonary emboli in the placebo group, one diagnosed by pulmonary angiography and the other by scintigraphy.Table 3Table 3
Deep-Vein Thrombosis in the Study Patients Undergoing Unilateral Hip Replacement Who Could Be Evaluated, According to the Location of the Thrombosis. shows the location of thrombi in the patients undergoing unilateral hip replacement who could be evaluated, according to whether the thrombi occurred in the leg that was operated on, the contralateral leg, or both legs. In 34 patients (18 percent) the thrombi occurred exclusively in the leg that was operated on, in 4 (2 percent) only in the contralateral leg, and in the remaining 12 (6 percent) in both legs.Rehospitalization because of deep-vein thrombosis was judged necessary for 32 patients in the placebo group and 11 patients in the enoxaparin group, for totals of 269 and 99 days, respectively (median duration of rehospitalization in the placebo group, 8.4 days [range, 4 to 29]; in the enoxaparin group, 9.0 days [range, 1 to 21]). The majority of patients (80 percent) were treated with low-molecular-weight heparin and warfarin. The remaining patients, who had small thrombi in muscular veins, were treated with elastic compression stockings, antiphlogistic agents, or both, without rehospitalization.
Clinical symptoms or signs of venous thromboembolism developed in 12 patients (included in Table 2) during the outpatient phase. Ten of these patients (eight with deep-vein thrombosis and two with pulmonary embolism) were in the placebo group, and two (both with deep-vein thrombosis) were in the enoxaparin group. The thrombi were all verified objectively. No further episodes of symptomatic thromboembolism occurred. No patients died during the post-discharge period.
Hemorrhagic Complications
Hematomas were seen at the injection site in one patient in the placebo group (1 percent) and six patients in the enoxaparin group (5 percent). Four patients in the placebo group and two patients in the enoxaparin group had decreases in hemoglobin of at least 2 g per deciliter; no patient had an absolute hemoglobin level below 8 g per deciliter. An increase in alanine aminotransferase to more than three times the upper limit of normal was found in one patient in the enoxaparin group. One patient in the enoxaparin group and none in the placebo group had mild thrombocytopenia (defined as a platelet count of 100,000 to 125,000 cells per cubic millimeter). This patient, a man 78 years old, had a preoperative platelet count of 263,000 per cubic millimeter. The count was lowest on postoperative day 23, at 121,000, and was 161,000 three days later. The patient's treatment was continued.
Other Adverse Events
There were no rehospitalizations for nonthrombotic, nonhemorrhagic causes. The incidence of adverse events leading to a discontinuation of the study medication, except for those related to venous thromboembolism, was similar in the two study groups. No patients died during the three months after randomization.
Discussion
In several studies, a beneficial effect of low-molecular-weight heparin in the prevention of postoperative thrombosis has been found.1,23-25 In our study, enoxaparin was used for routine prophylaxis during hospitalization in all patients. This prophylaxis was well tolerated, and there were no problems that could have been attributed to the administration of enoxaparin. It should be noted that the first dose was given about 12 hours before surgery, that the majority of patients (95 percent) received epidural or spinal anesthesia, and that in keeping with previous observations, no complications were observed in patients receiving enoxaparin and epidural anesthesia.26,27
The design of our study could be criticized in that patients in whom deep-vein thrombosis developed during the period of open-label therapy with enoxaparin were not identified and excluded before randomization. There were several reasons for the design we used. Ultrasonography is not optimal for the detection of thrombi in asymptomatic patients, especially distal and small proximal thrombi.28-30 Moreover, ultrasonography was not available at the time the study started. At least theoretically, phlebography performed at the time of discharge could have induced deep-vein thrombosis in some patients, although such a result is uncommon with the technique used in our hospital.31 Diagnostic surveillance is not routinely performed at hospital discharge in this population of patients. The frequency of deep-vein thrombosis at discharge is therefore unknown, but it was 11 percent at the same point in the study by Turpie et al.1 In our study, the 18 percent incidence of deep-vein thrombosis in the group given enoxaparin for one month may mean that there is a period of continued risk after hospital discharge even with extended prophylaxis, but that without such prophylaxis the risk is significantly higher.
In studies of patients undergoing hip-replacement surgery, bilateral phlebography must be used to diagnose deep-vein thrombosis. Ultrasonography lacks sensitivity as a screening instrument in asymptomatic patients.30 In our study, the use of a strict study protocol implemented by a few investigators made it possible to obtain adequate phlebograms in the vast majority of patients. Moreover, there was high compliance with the treatment protocol.
The main outcome was that prolonged prophylaxis with enoxaparin significantly reduced the incidence of venous thromboembolism; in addition, the frequency of proximal thrombi was significantly reduced. An important question is whether these findings have economic implications, but answering that question requires a formal economic analysis.9 The prophylactic effect at one month was in keeping with recently abstracted data32 and study findings.33 The frequency of clinical thromboembolism in the placebo group was equivalent to that recently reported in a study of total hip replacement in which there was no routine pharmacologic prophylaxis.34
Another important question is whether the beneficial results seen in this study can be reproduced in a routine clinical setting. Compliance was guaranteed in this trial because the study nurses administered the injections of the study drug. However, our clinical impression is that most patients, when motivated, are able to give themselves injections of the medication without difficulty.
In conclusion, patients receiving prophylaxis with enoxaparin for a full month after surgery had significantly less venous thromboembolic disease (most of which was asymptomatic), including proximal deep-vein thrombosis, than patients receiving enoxaparin prophylaxis only during their hospitalizations. In addition, there was a significant reduction in the incidence of symptomatic thromboembolic events.
Supported by a grant (00759) from the Swedish Medical Research Council, by the Swedish Heart and Lung Foundation, and by Rhône–Poulenc Rorer.
We are indebted to the project nurses, Christine Persson and Lill Borgström, for their efforts and contributions; to the following members of the research staff at Rhône–Poulenc Rorer for important contributions: Alistair Bone, Jean Bouthier, Sophie Combe, Jarl Molin, Ghislaine Pisapia, Björn Rubin, and Theodore Spiro; and to the following members of the research team for their dedication: Anne Guerriero, Mary Keiser, Ann Maher, Jennifer Rohr, Mary Jane Seipp, Susan Snyder, and Mary J. Sparks.
Source Information
From the Department of Surgery, Academic Hospital, Uppsala, Sweden (D.B.); the Departments of Orthopedic Surgery (G.B., H.F., U.H.) and Diagnostic Radiology (O.B., P.N., G.N.), Malmö University Hospital, Malmö, Sweden; and the Department of Research and Development, Rhône–Poulenc Rorer, Paris (S.N.).
Address reprint requests to Dr. Bergqvist at Academic Hospital, Department of Surgery, S-751 85 Uppsala, Sweden.
- References
References
1
Turpie AGG ,Levine MN ,Hirsh J , et al. A randomized controlled trial of a low-molecular-weight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Engl J Med 1986;315:925-929
Full Text | Web of Science | Medline2
Jorgensen LN ,Wille-Jorgensen P ,Hauch O . Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Br J Surg 1993;80:689-704
CrossRef | Web of Science | Medline3
Paiement GD ,Schutzer SF ,Wessinger SJ ,Harris WH . Influence of prophylaxis on proximal venous thrombus formation after total hip arthroplasty. J Arthroplasty 1992;7:471-475
CrossRef | Medline4
Mohr DN ,Silverstein MD ,Murtaugh PA ,Harrison JM . Prophylactic agents for venous thrombosis in elective hip surgery: meta-analysis of studies using venographic assessment. Arch Intern Med 1993;153:2221-2228
CrossRef | Web of Science | Medline5
Leizorovicz A ,Haugh MC ,Chapuis F-R ,Samama MM ,Boissel J-P . Low molecular weight heparin in prevention of perioperative thrombosis. BMJ 1992;305:913-920
CrossRef | Web of Science | Medline6
Nurmohamed MT ,Rosendaal FR ,Buller HR , et al. Low molecular weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet 1992;340:152-156
CrossRef | Web of Science | Medline7
Anderson DR ,O'Brien BJ ,Levine MN ,Roberts R ,Wells PS ,Hirsh J . Efficacy and cost of low-molecular-weight heparin compared with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. Ann Intern Med 1993;119:1105-1112
Web of Science | Medline8
Borris LC ,Lassen MR ,Jensen HP ,Andersen BS ,Poulsen KS . Perioperative thrombosis prophylaxis with low molecular weight heparins in elective hip surgery: clinical and economic considerations. Int J Clin Pharmacol Ther 1994;32:262-268
Web of Science | Medline9
Bergqvist D, Lindgren B, Mätzsch T. Cost-effectiveness of preventing postoperative deep vein thrombosis. In: Hull R, Pineo G, eds. Disorders of thrombosis. Philadelphia: W.B. Saunders, 1996:228-33.
10
Hampson WGJ ,Harris FC ,Lucas HK , et al. Failure of low-dose heparin to prevent deep-vein thrombosis after hip-replacement arthroplasty. Lancet 1974;2:795-797
CrossRef | Web of Science | Medline11
Mannucci PM ,Citterio LE ,Panajotopoulos N . Low-dose heparin and deep-vein thrombosis after total hip replacement. Thromb Haemost 1976;36:157-164
Web of Science | Medline12
Stamatakis JD ,Kakkar VV ,Sagar S ,Lawrence D ,Nairn D ,Bentley PG . Femoral vein thrombosis and total hip replacement. BMJ 1977;2:223-225
CrossRef | Web of Science | Medline13
Planes A ,Vochelle N ,Fagola M . Total hip replacement and deep vein thrombosis: a venographic and necropsy study. J Bone Joint Surg Br 1990;72:9-13
Web of Science | Medline14
McNally MA ,Mollan RAB . Total hip replacement, lower limb blood flow and venous thrombogenesis. J Bone Joint Surg Br 1993;75:640-644
Web of Science | Medline15
Scurr JH ,Coleridge-Smith PD ,Hasty JH . Deep venous thrombosis: a continuing problem. BMJ 1988;297:28-28
CrossRef | Web of Science | Medline16
Trowbridge A ,Boese CK ,Woodruff B ,Brindley HH Sr ,Lowry WE ,Spiro TE . Incidence of posthospitalization proximal deep venous thrombosis after total hip arthroplasty: a pilot study. Clin Orthop 1994;299:203-208
Web of Science | Medline17
Bergqvist D ,Lindblad B . A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients. Br J Surg 1985;72:105-108
CrossRef | Web of Science | Medline18
Huber O ,Bounameaux H ,Borst F ,Rohner A . Postoperative pulmonary embolism after hospital discharge: an underestimated risk. Arch Surg 1992;127:310-313
Web of Science | Medline19
Sevitt S ,Gallagher N . Venous thrombosis and pulmonary embolism: a clinico-pathological study in injured and burned patients. Br J Surg 1961;48:475-489
CrossRef | Web of Science | Medline20
Bergqvist D ,Fredin H . Pulmonary embolism and mortality in patients with fractured hips -- a prospective consecutive series. Eur J Surg 1991;157:571-574
Medline21
Schroder HM ,Andreassen M . Autopsy-verified major pulmonary embolism after hip fracture. Clin Orthop 1993;293:196-203
Web of Science | Medline22
Nicolaides A ,Arcelus J ,Belcaro G , et al. Prevention of venous thromboembolism. Int Angiol 1992;11:151-159
Web of Science | Medline23
Planes A ,Vochelle N ,Mazas F , et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost 1988;60:407-410
Web of Science | Medline24
Eriksson BI ,Zachrisson BE ,Teger-Nilsson AC ,Risberg B . Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br J Surg 1988;75:1053-1057
CrossRef | Web of Science | Medline25
Leyvraz PF ,Bachmann F ,Hoek J , et al. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ 1991;303:543-548[Erratum, BMJ 1991;303:1243.]
CrossRef | Web of Science | Medline26
Bergqvist D ,Lindblad B ,Matzsch T . Low molecular weight heparin for thromboprophylaxis and epidural/spinal anaesthesia -- is there a risk? Acta Anaesthesiol Scand 1992;36:605-609
CrossRef | Web of Science | Medline27
Vandermeulen EP ,Van Aken H ,Vermylen J . Anticoagulants and spinal-epidural anesthesia. Anesth Analg 1994;79:1165-1177
CrossRef | Web of Science | Medline28
Ginsberg JS ,Caco CC ,Brill-Edwards PA , et al. Venous thrombosis in patients who have undergone major hip or knee surgery: detection with compression US and impedance plethysmography. Radiology 1991;181:651-654
Web of Science | Medline29
Agnelli G ,Volpato R ,Radicchia S , et al. Detection of asymptomatic deep vein thrombosis by real-time B-mode ultrasonography in hip surgery patients. Thromb Haemost 1992;68:257-260
Web of Science | Medline30
Wells PS ,Lensing AW ,Davidson BL ,Prins MH ,Hirsh J . Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery: a meta-analysis. Ann Intern Med 1995;122:47-53
Web of Science | Medline31
Kristiansen P ,Bergentz S-E ,Bergqvist D ,Nylander G . Thrombosis after elective phlebography as demonstrated with the 125I-fibrinogen test. Acta Radiol Diagn (Stockh) 1981;22:577-580
Medline32
Dahl OE ,Andreassen G ,Muller C , et al. The effect of prolonged thromboprophylaxis with dalteparin on the frequency of deep vein thrombosis (DVT) and pulmonary embolism (PE) 35 days after hip replacement surgery (HRS). Thromb Haemost 1995;73:1094-1094 abstract.
Web of Science33
Planes A, Vochelle N, Fagola M, et al. Persistence of the risk of deep venous thrombosis after hospital discharge in patients undergoing total hip replacement. Lancet (in press).
34
Warwick D ,Williams MH ,Bannister GC . Death and thromboembolic disease after total hip replacement: a series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br 1995;77:6-10
Web of Science | Medline
- Citing Articles (146)
Citing Articles
1
D. Bergqvist, J. I. Arcelus, P. Felicissimo, . (2012) Evaluation of the duration of thromboembolic prophylaxis after high-risk orthopaedic surgery: The ETHOS observational study. Thrombosis and Haemostasis 107:2,
CrossRef2
D. Bergqvist, J. I. Arcelus, P. Felicissimo, . (2012) Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery. Thrombosis and Haemostasis 107:2,
CrossRef3
Ernest Kwek, Richard E. Buckley. 2011. Thromboprophylaxis in Orthopedic Practice. , 56-71.
CrossRef4
Steve Kwon, Mark Meissner, Rebecca Symons, Scott Steele, Richard Thirlby, Rick Billingham, David R. Flum. (2011) Perioperative Pharmacologic Prophylaxis for Venous Thromboembolism in Colorectal Surgery. Journal of the American College of Surgeons 213:5, 596-603.e1
CrossRef5
J.-M. Baud, G. Matrand, J.-L. Georges, P. Beaufils, B. Livarek. (2011) Dépistage clinique de la thrombose veineuse profonde après prothèse de hanche et de genou. Proposition d’un score de prédiction pour guider l’indication de l’échographie-Doppler veineux. Journal des Maladies Vasculaires
CrossRef6
J. E. Stark, W. J. Smith. (2011) Standard or extended-duration prophylaxis in medical patients? A review of the evidence. Journal of Thrombosis and Thrombolysis 32:3, 318-327
CrossRef7
Taki Galanis, Walter K. Kraft, Geno J. Merli. (2011) Prophylaxis for Deep Vein Thrombosis and Pulmonary Embolism in the Surgical Patient. Advances in Surgery 45:1, 361-390
CrossRef8
Woo Jung Park, Sang-Ho Jo, Sung-Ai Kim, Hyun-Sook Kim, Sang-Jin Han, Young Jin Choi, Chong-Yun Rhim. (2011) Rationale and design of STOP DVT study: Rosuvastatin for the prevention of deep vein thrombosis in patients undergoing total knee replacement arthroplasty — A prospective randomized open-label controlled trial. Contemporary Clinical Trials 32:5, 779-782
CrossRef9
Ricky Autar. (2011) Evidence based venous thromboprophylaxis in patients undergoing total hip replacement (THR), total knee replacement (TKR) and hip fracture surgery (HFS). International Journal of Orthopaedic and Trauma Nursing 15:3, 145-154
CrossRef10
Davide Imberti, Cosetta Bianchi, Antonella Zambon, Andrea Parodi, Luca Merlino, Massimo Gallerani, Giovanni Corrao. (2011) Venous thromboembolism after major orthopaedic surgery: a population-based cohort study. Internal and Emergency Medicine
CrossRef11
Jawed Fareed, Cafer Adiguzel, Indermohan Thethi. (2011) Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism. Thrombosis Journal 9:1, 5
CrossRef12
M. H. Huo. (2011) New oral anticoagulants in venous thromboembolism prophylaxis in orthopaedic patients: Are they really better?. Thrombosis and Haemostasis 106:1, 45-57
CrossRef13
Carsten Perka. (2011) Preoperative versus postoperative initiation of thromboprophylaxis following major orthopedic surgery: safety and efficacy of postoperative administration supported by recent trials of new oral anticoagulants. Thrombosis Journal 9:1, 17
CrossRef14
Donna Dizon-Townson. 2010. Thromboembolic Disease. , 283-307.
CrossRef15
James Muntz. (2010) Duration of deep vein thrombosis prophylaxis in the surgical patient and its relation to quality issues. The American Journal of Surgery 200:3, 413-421
CrossRef16
(2010) Meeting the Unmet Needs in Anticoagulant Therapy. European Journal of Haematology 85, 1-28
CrossRef17
Alpesh N. Amin, Jay Lin, Amy Ryan. (2010) Need to improve thromboprophylaxis across the continuum of care for surgical patients. Advances in Therapy 27:2, 81-93
CrossRef18
Hang-Seob Yoon, Chang-Dong Han, Ick-Hwan Yang. (2010) Comparison of Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Terms of Perioperative Complications. The Journal of Arthroplasty 25:2, 179-185
CrossRef19
Ciarán T. Bradley, Karen J. Brasel, Jessica Jane Miller, Sam G. Pappas. (2010) Cost-Effectiveness of Prolonged Thromboprophylaxis After Cancer Surgery. Annals of Surgical Oncology 17:1, 31-39
CrossRef20
Michael B. Cross, Friedrich Boettner. (2009) Pathophysiology of Venous Thromboembolic Disease. Seminars in Arthroplasty 20:4, 210-216
CrossRef21
Gabriella Szücs, Éva Ajzner, László Muszbek, Tünde Simon, Kálmán Szepesi, Béla Fülesdi. (2009) Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery. Journal of Orthopaedic Science 14:5, 484-490
CrossRef22
Daniel Dindo, Stefan Breitenstein, Dieter Hahnloser, Burkhardt Seifert, Sidika Yakarisik, Lars M Asmis, Markus K Muller, Pierre-Alain Clavien. (2009) Kinetics of D-dimer after general surgery. Blood Coagulation & Fibrinolysis 20:5, 347-352
CrossRef23
Alejandro Lazo-Langner, Marc A. Rodger. (2009) Overview of Current Venous Thromboembolism Protocols in Hip Reconstruction. Orthopedic Clinics of North America 40:3, 427-436
CrossRef24
Michael H. Huo, James Muntz. (2009) Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: A review. Clinical Therapeutics 31:6, 1129-1141
CrossRef25
Elias Kfoury, Ali Taher, Said Saghieh, Zaher K. Otrock, Rami Mahfouz. (2009) The impact of inherited thrombophilia on surgery: A factor to consider before transplantation?. Molecular Biology Reports 36:5, 1041-1051
CrossRef26
David Bergqvist. (2009) Thromboprophylaxis in gynaecologic surgery. Thrombosis Research 123, S5-S7
CrossRef27
Javier Granero Xiberta, José María Soler Minoves, Laura Garcia Nuño. (2008) Enfermedad tromboembólica en pacientes de cirugía ortopédica. Medicina Clínica 131, 18-24
CrossRef28
Ajay K Kakkar, Benjamin Brenner, Ola E Dahl, Bengt I Eriksson, Patrick Mouret, Jim Muntz, Andrea G Soglian, Ákos F Pap, Frank Misselwitz, Sylvia Haas. (2008) Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. The Lancet 372:9632, 31-39
CrossRef29
Eriksson, Bengt I., Borris, Lars C., Friedman, Richard J., Haas, Sylvia, Huisman, Menno V., Kakkar, Ajay K., Bandel, Tiemo J., Beckmann, Horst, Muehlhofer, Eva, Misselwitz, Frank, Geerts, William, . (2008) Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty. New England Journal of Medicine 358:26, 2765-2775
Full Text30
GENO J. MERLI, GEORGE L. TZANIS, L. BERNARD MENAJOVSKY. 2008. Prophylaxis for Deep Vein Thrombosis and Pulmonary Embolism in the Surgical Patient. , 91-115.
CrossRef31
François J. Singelyn, Cees C.P.M. Verheyen, Franco Piovella, Hugo K. Van Aken, Nadia Rosencher. (2007) The Safety and Efficacy of Extended Thromboprophylaxis With Fondaparinux After Major Orthopedic Surgery of the Lower Limb With or Without a Neuraxial or Deep Peripheral Nerve Catheter: The EXPERT Study. Anesthesia & Analgesia 105:6, 1540-1547
CrossRef32
Antoine Cherfan, Yaseen Arabi, Ahmed Al Askar, Abdullah Al Shimemeri. (2007) Recombinant Activated Factor VII Treatment of Retroperitoneal Hematoma in a Patient with Renal Failure Receiving Enoxaparin and Clopidogrel. Pharmacotherapy 27:5, 755-759
CrossRef33
Sharon Craven, Lori Dewar, Xianjun Yang, Jeff Ginsberg, Frederick Ofosu. (2007) Altered regulation of in-vivo coagulation in orthopedic patients prior to knee or hip replacement surgery. Blood Coagulation & Fibrinolysis 18:3, 219-225
CrossRef34
A. G. G. TURPIE. (2007) Extended duration of thromboprophylaxis in acutely ill medical patients: optimizing therapy?. Journal of Thrombosis and Haemostasis 5:1, 5-11
CrossRef35
Matthew L. Ortman, Todd E.H. Hecht. 2007. Prevention of Venous Thromboembolism in the Surgical Patient. , 151-222.
CrossRef36
Vincent D Pellegrini, Christopher T Donaldson, Daniel C Farber, Erik B Lehman, C McCollister Evarts. (2006) The Mark Coventry Award: Prevention of Readmission for Venous Thromboembolism after Total Knee Arthroplasty. Clinical Orthopaedics and Related Research 452, 21-27
CrossRef37
G. M. Ivanic, I. Moser, N. C. Homann, M. Pietsch, P. Kriechhammer, A. Hennerbichler. (2006) Die intermittierende Impulskompression zur Abschwellung und Thromboseprophylaxe – Pilotstudie nach Hüft-TEP. Der Unfallchirurg 109:9, 786-792
CrossRef38
M COPPENS. (2006) Inherited Thrombophilias. Obstetrics and Gynecology Clinics of North America 33:3, 357-374
CrossRef39
N. ROSENCHER, C. VIELPEAU, J. EMMERICH, C. M. SAMAMA. (2006) More on: venous thromboembolism and mortality after hip fracture: the ESCORTE study. Journal of Thrombosis and Haemostasis 4:7, 1645-1647
CrossRef40
Patrick Tilleul, Gaëlle Tredan, Géraldine Austruy, Eric Maury, Georges Offenstadt, Bertrand Guidet. (2006) Prophylactic low-molecular-weight heparin: Prescription practice in an intensive care unit. Journal of Critical Care 21:2, 173-178
CrossRef41
Serge Motte, Charles Marc Samama, Joanne Guay, Jeanne Barrê, Jeanne-Yvonne Borg, Nadia Rosencher. (2006) Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 53:S2, S68-S79
CrossRef42
Matthias Bischof, Jörg D Leuppi, Pedram Sendi. (2006) Cost–effectiveness of extended venous thromboembolism prophylaxis with fondaparinux in hip surgery patients. Expert Review of Pharmacoeconomics & Outcomes Research 6:2, 171-180
CrossRef43
Masaki Kiyomura, Tomihiro Katayama, Yasuki Kusanagi, Masaharu Ito. (2006) Ranking the contributing risk factors in venous thrombosis in terms of therapeutic potential: Virchow's triad revisited. Journal of Obstetrics and Gynaecology Research 32:2, 216-223
CrossRef44
Cedric Hermans, Donald Claeys. (2006) Review of the rebound phenomenon in new anticoagulant treatments. Current Medical Research and Opinion 22:3, 471-481
CrossRef45
Enrique Ginzburg, Kresimir Banovac, Bryce Epstein, Kester Nedd, Murray Rolnick, Scott Tannenbaum. (2006) Thromboprophylaxis in Medical and Surgical Patients Undergoing Physical Medicine and Rehabilitation. American Journal of Physical Medicine & Rehabilitation 85:2, 159-166
CrossRef46
Hakan Senaran, Emre Acaroğlu, H. Mustafa Özdemir, Bulent Atilla. (2006) Enoxaparin and heparin comparison of deep vein thrombosis prophylaxis in total hip replacement patients. Archives of Orthopaedic and Trauma Surgery 126:1, 1-5
CrossRef47
Vincent D Pellegrini, Christopher T Donaldson, Daniel C Farber, Erik B Lehman, C McCollister Evarts. (2005) THE JOHN CHARNLEY AWARD: Prevention of Readmission for Venous Thromboembolic Disease after Total Hip Arthroplasty. Clinical Orthopaedics and Related Research 441:&NA;, 56-62
CrossRef48
John C. Rowlingson, Peter B. Hanson. (2005) Neuraxial Anesthesia and Low-Molecular-Weight Heparin Prophylaxis in Major Orthopedic Surgery in the Wake of the Latest American Society of Regional Anesthesia Guidelines. Anesthesia & Analgesia 100:5, 1482-1488
CrossRef49
A. KHER, M. M. SAMAMA. (2005) Primary and secondary prophylaxis of venous thromboembolism with low-molecular-weight heparins: prolonged thromboprophylaxis, an alternative to vitamin K antagonists. Journal of Thrombosis and Haemostasis 3:3, 473-481
CrossRef50
James Muntz, David A Scott, Adam Lloyd, Matthias Egger. (2004) Major bleeding rates after prophylaxis against venous thromboembolism: Systematic review, meta-analysis, and cost implications. International Journal of Technology Assessment in Health Care 20:04,
CrossRef51
A. Planes. (2004) Prevention of venous thromboembolism after orthopedic surgery: the EXPRESS study. Journal of Thrombosis and Haemostasis 2:11, 2037-2039
CrossRef52
Patrick Haentjens, Katrien De Groote, Lieven Annemans. (2004) Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. A cost-utility analysis.. Archives of Orthopaedic and Trauma Surgery 124:8, 507-517
CrossRef53
Paul P. Dobesh. (2004) Evidence for Extended Prophylaxis in the Setting of Orthopedic Surgery. Pharmacotherapy 24:7 Part 2, 73S-81S
CrossRef54
A.G.G. Turpie. (2004) The design of venous thromboembolism prophylaxis trials: Fondaparinux is definitely more effective than enoxaparin in orthopaedic surgery. International Journal of Clinical Practice 58:5, 483-493
CrossRef55
Samuel Z Goldhaber. (2004) Pulmonary embolism. The Lancet 363:9417, 1295-1305
CrossRef56
Graham Pineo, Russell Hull, Victor Marder. (2004) Oral delivery of heparin: SNAC and related formulations. Best Practice & Research Clinical Haematology 17:1, 153-160
CrossRef57
David Bergqvist, Jan-Helge Solhaug, Lena Holmdahl, Ulf G Eriksson, Magnus Andersson, Barbro Boberg, Mats ??gren. (2004) Pharmacokinetics, Preliminary Efficacy and Safety of Subcutaneous Melagatran and Oral Ximelagatran. Clinical Drug Investigation 24:3, 127-136
CrossRef58
Jari Siironen, Seppo Juvela, Joona Varis, Matti Porras, Kristiina Poussa, Sorella Ilveskero, Juha Hernesniemi, Riitta Lassila. (2003) No effect of enoxaparin on outcome of aneurysmal subarachnoid hemorrhage: a randomized, double-blind, placebo-controlled clinical trial. Journal of Neurosurgery 99:6, 953-959
CrossRef59
Philip C. Comp. (2003) Selective Factor Xa Inhibition Improves Efficacy of Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Pharmacotherapy 23:6, 772-787
CrossRef60
H. Arnesen, O. E. Dahl, T. Aspelin, I. Seljeflot, P. Kierulf, T. Lyberg. (2003) Sustained prothrombotic profile after hip replacement surgery: the influence of prolonged prophylaxis with dalteparin. Journal of Thrombosis and Haemostasis 1:5, 971-975
CrossRef61
O. E. Dahl, A. M. Pleil. (2003) Investment in prolonged thromboprophylaxis with dalteparin improves clinical outcomes after hip replacement. Journal of Thrombosis and Haemostasis 1:5, 896-906
CrossRef62
David Bergqvist. (2003) Assessment of the Risk and the Prophylaxis of Venous Thromboembolism in Surgical Patients. Pathophysiology of Haemostasis and Thrombosis 33:5-6, 358-361
CrossRef63
Ola E Dahl, Tor E Gudmundsen, Bård T Bjørnarå, Dag M Solheim. (2003) Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital. Acta Orthopaedica 74:3, 299-304
CrossRef64
Sean D Sullivan, Susan R Kahn, Bruce L Davidson, Lars Borris, Patrick Bossuyt, Gary Raskob. (2003) Measuring the Outcomes and Pharmacoeconomic Consequences of Venous Thromboembolism Prophylaxis in Major Orthopaedic Surgery. PharmacoEconomics 21:7, 477-496
CrossRef65
M. T. Barrellier. (2002) Thromboprophylaxis and total hip replacement: A cost-efficacy study comparing duplex screening of asymptomatic venous thrombosis versus prolonged prophylaxis with low-molecular-weight heparins. Phlebology 17:3-4, 93-97
CrossRef66
J. A. Caprini, J. I. Arcelus, J. C. Kudrna, L. R. Sehgal, M. Oyslender, D. Maksimovic, A. MacDougall. (2002) Cost-effectiveness of venous thromboembolism prophylaxis after total hip replacement. Phlebology 17:3-4, 126-133
CrossRef67
Helen HG Handoll, Mark J Farrar, Julie McBirnie, Graham M Tytherleigh-Strong, Alan A Milne, William J Gillespie, Helen HG Handoll. 2002. Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures. .
CrossRef68
Philip C Comp, Jeffrey D Miller, Kevin W Mayo, Samuel Wagner, Mason W Russell. (2002) Outcomes of dalteparin use following total knee arthroplasty: a retrospective analysis. Expert Review of Pharmacoeconomics & Outcomes Research 2:5, 427-434
CrossRef69
Lassen, Michael R., Borris, Lars C., Nakov, Roumen L., . (2002) Use of the Low-Molecular-Weight Heparin Reviparin to Prevent Deep-Vein Thrombosis after Leg Injury Requiring Immobilization. New England Journal of Medicine 347:10, 726-730
Full Text70
Ola E. Dahl, David Bergqvist. (2002) Current controversies in deep vein thrombosis prophylaxis after orthopaedic surgery. Current Opinion in Pulmonary Medicine 8:5, 394-397
CrossRef71
Richard H. White, Mark C. Henderson. (2002) Risk factors for venous thromboembolism after total hip and knee replacement surgery. Current Opinion in Pulmonary Medicine 8:5, 365-371
CrossRef72
Morten S Rasmussen. (2002) Preventing thromboembolic complications in cancer patients after surgery: a role for prolonged thromboprophylaxis. Cancer Treatment Reviews 28:3, 141-144
CrossRef73
Jacqueline A Mason, Alexander GG Turpie. (2002) Review of enoxaparin and its clinical applications in venous and arterial thromboembolism. Expert Opinion on Pharmacotherapy 3:5, 575-598
CrossRef74
Marc Heizmann, Gabriela M Baerlocher, Felix Steinmann, Fritz F Horber, Walter A Wuillemin. (2002) Anti-Xa activity in obese patients after double standard dose of nadroparin for prophylaxis. Thrombosis Research 106:4-5, 179-181
CrossRef75
Bergqvist, David, Agnelli, Giancarlo, Cohen, Alexander T., Eldor, Amiram, Nilsson, Paul E., Le Moigne-Amrani, Anne, Dietrich-Neto, Flavia, . (2002) Duration of Prophylaxis against Venous Thromboembolism with Enoxaparin after Surgery for Cancer. New England Journal of Medicine 346:13, 975-980
Full Text76
David Bergqvist. (2002) Enoxaparin. PharmacoEconomics 20:4, 225-243
CrossRef77
Stein Atle Lie, Lars Birger Engesaeter, Leif Ivar Havelin, Ove Furnes, Stein Emil Vollset. (2002) Early postoperative mortality after 67,548 total hip replacements. Acta Orthopaedica 73:4, 392-399
CrossRef78
Robert Krotenberg, Uri Adler, Bruce Pomeranz, Jeffrey D. Miller, Mason W. Russell. (2001) Dalteparin vs. Enoxaparin as Prophylaxis for Deep-Vein Thrombosis After Total Hip or Knee Arthroplasty. American Journal of Physical Medicine & Rehabilitation 80:12, 889-895
CrossRef79
André Kher. (2001) Critical appraisal of current antithrombotic trials in patients undergoing total hip replacement. Expert Opinion on Investigational Drugs 10:12, 2175-2183
CrossRef80
W. E. Wade, W. J. Spruill. (2001) Cost comparison of tinzaparin versus enoxaparin as deep venous thrombosis prophylaxis in spinal cord injury: preliminary data. Blood Coagulation & Fibrinolysis 12:8, 619-625
CrossRef81
Geoffrey H. Westrich, Adam J. Rana. (2001) Prevention and Treatment of Thromboembolic Disease: An Overview. Techniques in Orthopaedics 16:3, 279-290
CrossRef82
Geno J. Merli. (2001) DURATION OF DEEP VEIN THROMBOSIS AND PULMONARY EMOLISM PROPHYLAXIS AFTER JOINT ARTHROPLASTY. Medical Clinics of North America 85:5, 1101-1107
CrossRef83
J Mesko. (2001) Venous thromboembolic disease management patterns in total hip arthroplasty and total knee arthroplasty patients A survey of the AAHKS membership. The Journal of Arthroplasty 16:6, 679-688
CrossRef84
Russell D Hull, Graham F Pineo. (2001) Dalteparin sodium. Expert Opinion on Pharmacotherapy 2:8, 1325-1337
CrossRef85
John W Eikelboom, Daniel J Quinlan, James D Douketis. (2001) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. The Lancet 358:9275, 9-15
CrossRef86
B. Bendz, K. Sevre, T. O. Andersen, P. M. Sandset. (2001) Low molecular weight heparin prevents activation of coagulation in a hypobaric environment. Blood Coagulation and Fibrinolysis 12:5, 371-374
CrossRef87
Graham F. Pineo. (2001) New Developments in the Prevention and Treatment of Venous Thromboembolism. Pharmacotherapy 21:6 Part 2, 51S-55S
CrossRef88
Larry M. Lopez. (2001) Low-Molecular-Weight Heparins Are Essentially the Same for Treatment and Prevention of Venous Thromboembolism. Pharmacotherapy 21:6 Part 2, 56S-61S
CrossRef89
David Bergqvist. (2001) Venous Thromboembolism and Cancer: Prevention of VTE. Thrombosis Research 102:6, V209-V213
CrossRef90
Peer Wille-Jørgensen. (2001) The potential role of new therapies in deep-vein thrombosis prophylaxis. Seminars in Hematology 38, 20-30
CrossRef91
Giancarlo Agnelli, Cecilia Becattini. (2001) Clinical and economic aspects of managing venous thromboembolism in the outpatient setting. Seminars in Hematology 38, 58-66
CrossRef92
Beth A. Duplaga, Christina W. Rivers, Edith Nutescu. (2001) Dosing and Monitoring of Low-Molecular-Weight Heparins in Special Populations. Pharmacotherapy 21:2, 218-234
CrossRef93
Daniel A. Oakes, Jay R. Lieberman. (2001) Thromboembolism after total hip replacement. Current Opinion in Orthopedics 12:1, 71-78
CrossRef94
Göran Benoni, Hans Fredin, Richard Knebel, Paul Nilsson. (2001) Blood conservation with tranexamic acid in total hip arthroplasty: A randomized, double-blind study in 40 primary operations. Acta Orthopaedica 72:5, 442-448
CrossRef95
Laurie G. Jacobs. (2001) In reply. Journal of the American Geriatrics Society 49:1, 96-97
CrossRef96
Russell D. Hull, Graham F. Pineo, Susan MacIsaac. (2001) Low-Molecular-Weight Heparin Prophylaxis: Preoperative Versus Postoperative Initiation in Patients Undergoing Elective Hip Surgery. Thrombosis Research 101:1, 155-162
CrossRef97
John A. Heit. (2001) Low-Molecular-Weight Heparin: The Optimal Duration of Prophylaxis Against Postoperative Venous Thromboembolism After Total Hip or Knee Replacement. Thrombosis Research 101:1, 163-173
CrossRef98
O E Dahl, D Bergqvist, A T Cohen, S P Frostick, R D Hull, B M Persson. (2001) Low-molecular-weight heparin as prophylaxis against thromboembolism after total hip replacement--The never-ending story?. Acta Orthopaedica 72:2, 199-204
CrossRef99
Richard Schreiber. (2001) Regarding clinical practice guidelines on the use of warfarin. Journal of the American Geriatrics Society 49:1, 96-96
CrossRef100
White, Richard H., Gettner, Sharmeen, Newman, Jeffrey M., Trauner, Kenneth B., Romano, Patrick S., . (2000) Predictors of Rehospitalization for Symptomatic Venous Thromboembolism after Total Hip Arthroplasty. New England Journal of Medicine 343:24, 1758-1764
Full Text101
Ola Björgell, Paul E Nilsson, Göran Benoni, David Bergqvist. (2000) Symptomatic and Asymptomatic Deep Vein Thrombosis After Total Hip Replacement. Differences in Phlebographic Pattern, Described by a Scoring of the Thrombotic Burden. Thrombosis Research 99:5, 429-438
CrossRef102
L. Connie Marras, William H. Geerts, James R. Perry. (2000) The risk of venous thromboembolism is increased throughout the course of malignant glioma. Cancer 89:3, 640-646
CrossRef103
G Agnelli, R Rossi, M.G Santamaria. (2000) Management of thromboembolism in the outpatient setting. Seminars in Hematology 37, 23-26
CrossRef104
Christopher J. Dunn, Blair Jarvis. (2000) Dalteparin. Drugs 60:1, 203-237
CrossRef105
Anthony T. Gerlach, Kerry K. Pickworth, Shiv K. Seth, Saloni B. Tanna, Julie F. Barnes. (2000) Enoxaparin and Bleeding Complications: A Review in Patients with and without Renal Insufficiency. Pharmacotherapy 20:7, 771-775
CrossRef106
(2000) Thromboembolism and thromboprophylaxis in high risk surgery: facts and assumptions - a topic for emotions?. European Journal of Anaesthesiology 17:6, 343-347
CrossRef107
O. E. Dahl. (2000) Thromboembolism and thromboprophylaxis in high risk surgery: facts and assumptions - a topic for emotions?. European Journal of Anaesthesiology 17:6, 343-347
CrossRef108
B. Bendz, T. O. Andersen, P. M. Sandset. (2000) Dose-dependent release of endogenous tissue factor pathway inhibitor by different low molecular weight heparins. Blood Coagulation and Fibrinolysis 11:4, 343-348
CrossRef109
Hervé Sors, Guy Meyer. (2000) Place of aspirin in prophylaxis of venous thromboembolism. The Lancet 355:9212, 1288-1289
CrossRef110
Carlos A. Estrada, Christopher J. Mansfield, Gustavo R. Heudebert. (2000) Cost-effectiveness of Low-Molecular-Weight Heparin in the Treatment of Proximal Deep Vein Thrombosis. Journal of General Internal Medicine 15:2, 108-115
CrossRef111
Ola E Dahl, Tor E Gudmundsen, Lars Haukeland. (2000) Late occurring clinical deep vein thrombosis in joint-operated patients. Acta Orthopaedica 71:1, 47-50
CrossRef112
William E. Wade, Bradley C. Martin, Jeffrey A. Kotzan, William J. Spruill, Marie A. Chisoholm, Matthew Perri. (2000) Formulary Management of Low Molecular Weight Heparins. PharmacoEconomics 17:1, 1-12
CrossRef113
Geno J. Merli. (2000) Prophylaxis for deep venous thrombosis and pulmonary embolism in the surgical patient. Clinical Cornerstone 2:4, 15-25
CrossRef114
Göran Benoni, Stefan Lethagen, Paul Nilsson, Hans Fredin. (2000) Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty. Acta Orthopaedica 71:3, 250-254
CrossRef115
Björn M Persson. (2000) Low-molecular weight heparin as prophylaxis against thromboembolism after total hip replacement--is it worth the price?. Acta Orthopaedica 71:2, 215-216
CrossRef116
Richard J. Friedman, Greg A. Dunsworth. (2000) Cost Analyses of Extended Prophylaxis With Enoxaparin After Hip Arthroplasty. Clinical Orthopaedics and Related Research 370, 171-182
CrossRef117
Giancarlo Agnelli, Francesco Sonaglia. (2000) Prevention of Venous Thromboembolism. Thrombosis Research 97:1, V49-V62
CrossRef118
Joseph A. Caprini, Juan I. Arcelus, Gary Motykie, James C. Kudrna, David Mokhtee, José J. Reyna. (1999) The influence of oral anticoagulation therapy on deep vein thrombosis rates four weeks after total hip replacement. Journal of Vascular Surgery 30:5, 813-820
CrossRef119
Samama, Meyer Michel, Cohen, Alexander Thomas, Darmon, Jean-Yves, Desjardins, Louis, Eldor, Amiram, Janbon, Charles, Leizorovicz, Alain, Nguyen, Hélène, Olsson, Carl-Gustav, Turpie, Alexander Graham, Weisslinger, Nadine, . (1999) A Comparison of Enoxaparin with Placebo for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients. New England Journal of Medicine 341:11, 793-800
Full Text120
Ryan R. Davies, Michael A. Coady, Graeme L. Hammond, John A. Elefteriades, Richard J. Gusberg. (1999) Low molecular weight heparin: An evaluation of current and potential clinical utility in surgery. International Journal of Angiology 8:4, 203-215
CrossRef121
Scott F. Rosen, G. Patrick Clagett. (1999) Prevention of venous thromboembolism. Current Opinion in Hematology 6:5, 285-290
CrossRef122
Geno J. Merli. (1999) DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM PROPHYLAXIS IN JOINT REPLACEMENT SURGERY. Rheumatic Disease Clinics of North America 25:3, 639-656
CrossRef123
David Bergqvist, Bengt Jönsson. (1999) Cost-Effectiveness of Prolonged Administration of a Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis Following Total Hip Replacement. Value in Health 2:4, 288-294
CrossRef124
M SHAIEB, B WATSON, R ATKINSON. (1999) Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis. The Journal of Arthroplasty 14:4, 432-438
CrossRef125
Knute O. Beuhler, Darryl D. D'Lima, Clifford W. Colwell, Shirley M. Otis, Richard H. Walker. (1999) Venous Thromboembolic Disease After Hybrid Hip Arthroplasty With Negative Duplex Screening. Clinical Orthopaedics and Related Research 361, 168-177
CrossRef126
L TAMIR, D HENDEL, C NEYMAN, A ESHKENAZI, Y BENZVI, R ZOMER. (1999) Sequential foot compression reduces lower limb swelling and pain after total knee arthroplasty. The Journal of Arthroplasty 14:3, 333-338
CrossRef127
J HOUDE, G STEINBERG. (1999) Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty. The Journal of Arthroplasty 14:3, 372-374
CrossRef128
(1999) Commentaries on thromboprophylaxis in hip replacement surgery: Thromboembolism–An academic concern or a clinical reality?. Acta Orthopaedica 70:4, 403-406
CrossRef129
Goldhaber, Samuel Z., . (1998) Pulmonary Embolism. New England Journal of Medicine 339:2, 93-104
Full Text130
David Bergqvist. (1998) MODERN ASPECTS OF PROPHYLAXIS AND THERAPY FOR VENOUS THROMBO-EMBOLIC DISEASE. ANZ Journal of Surgery 68:7, 463-468
CrossRef131
John-Bjarne Hansen, Per Morten Sandset, Kirsten Raanaas Huseby, Nils-Erik Huseby, Bjorn Bendz, Per Ostergaard, Arne Nordoy. (1998) Differential effect of unfractionated heparin and low molecular weight heparin on intravascular tissue factor pathway inhibitor: evidence for a difference in antithrombotic action. British Journal of Haematology 101:4, 638-646
CrossRef132
Russell D. Hull, Graham F. Pineo. (1998) PROPHYLAXIS OF DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM. Medical Clinics of North America 82:3, 477-493
CrossRef133
M.R Lassen, L.C Borris, B.S Anderson, H.P Jensen, H.P.Skejø Bro, G Andersen, A.O Petersen, P Siem, E Hørlyck, B.V Jensen, P.B Thomsen, B.R Hansen, J Erin-Madsen, J.C Møller, L Rotwitt, F Christensen, J.B Nielsen, P.S Jørgensen, B Paaske, C Tørholm, P Hvidt, N.K Jensen, A.B Nielsen, E Appelquist, O.G Hansen, D Mortensen, E Tjalve. (1998) Efficacy and Safety of Prolonged Thromboprophylaxis with a Low Molecular Weight Heparin (Dalteparin) after Total Hip Arthroplasty— The Danish Prolonged Prophylaxis (DaPP) Study. Thrombosis Research 89:6, 281-287
CrossRef134
John M. Porter. (1998) Vascular Surgery. Journal of the American College of Surgeons 186:2, 247-262
CrossRef135
Jules A Shafer. (1998) Cardiovascular chemotherapy: anticoagulants. Current Opinion in Chemical Biology 2:4, 458-465
CrossRef136
Ola E Dahl. (1998) Thromboprophylaxis in hip arthroplasty: New frontiers and future strategy. Acta Orthopaedica 69:4, 339-342
CrossRef137
MONICA NORDSTRÖM, BENGT LINDBLAD. (1998) Autopsy-verified venous thromboembolism within a defined urban population - the city of Malmö, Sweden. APMIS 106:1-6, 378-384
CrossRef138
(1998) Übersicht. LaboratoriumsMedizin 22:3, 134-140
CrossRef139
Liguo Chi, Karen L Rogers, Andrew CG Uprichard, Kim P. Gallagher. (1997) The therapeutic potential of novel anticoagulants. Expert Opinion on Investigational Drugs 6:11, 1591-1605
CrossRef140
(1997) Efficacy and safety of enoxaparinversus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: A double-blind randomized multicentre trial with venographic assessment. British Journal of Surgery 84:8, 1099-1103
CrossRef141
Jawed Fareed, Debra Hoppensteadt, Walter Jeske, Rana Clarizio, Jeanine M Walenga. (1997) Low molecular weight heparins: a developmental perspective. Expert Opinion on Investigational Drugs 6:6, 705-733
CrossRef142
Corina R Canova, Manuel P Fischler, Walter H Reinhart. (1997) Effect of low-molecular-weight heparin on serum potassium. The Lancet 349:9063, 1447-1448
CrossRef143
J. David Talley, Thomas D. Conley. (1997) Progress in Interventional Cardiology. Journal of Interventional Cardiology 10:2, 163-169
CrossRef144
(1997) Enoxaparin as Prophylaxis against Thromboembolism after Total Hip Replacement. New England Journal of Medicine 336:8, 585-586
Full Text145
(1997) REVIEW. Clinical Chemistry and Laboratory Medicine 35:7, 501-516
CrossRef146
A Planes, N Vochelle, JY Darman. (1996) Post-discharge deep-vein thrombosis after orthopaedic surgery. The Lancet 348:9035, 1179-1180
CrossRef
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