Scientific journal
Научное обозрение. Медицинские науки
ISSN 2500-0780
ПИ №ФС77-57452

Personal portfolio

ELEVATED DOSES OF UNFRACTIONED HEPARIN IN PREVENTION OF POSTOPERATIVE VENOUS THROMBOEMBOLISM IN HIGH RISK PATIENTS: EFFICACY AND SAFETY

Barinov V.Е. 1 Lobastov K.V. 1 Boyarintsev V.V. 1 Schastlivtsev I.V. 1
1 Clinical Hospital no. 1 of President’s Administration of Russian Federation
The aim of the study was to assess the efficacy and safety of elevated doses of unfractioned heparin (UH) in prevention of postoperative venous thromboembolism in high risk patients.Materials and methods: it was a prospective randomized controlled blind study, included 234 high risk surgical patients after abdominal (50%) or intracranial/spinal (50%) surgery. According to VTE prophylaxis protocol all patients were randomized into 3 groups: 100, 100 and 34 patients in each. In all groups compression medical stockings with pressure 23-32mm.Hg were applied. In group 1 standard low-doses unfractioned heparin was prescribed: 5000U t.i.d. In group 2 were used individual daily doses of UH, counted as 300U/kg of body mass daily. In group 3 – 500 U/kg daily. The venous capacity was evaluated by duplex ultrasound at baseline and then every 3-5 days until discharge. Pulmonary embolism was verified by lung scintigraphy and/or heart ultrasound and autopsy. Also was evaluated the rate of big hemorrhagic complications.Results. The rate of postoperative venous thrombosis was: 19,0% (95 % CI: 11,3–26,7 %) in the group 1; 5,0% (2,2–11,2 %) in the group 2; and 2,9 % (0,5–14,9 %) in the group 3 (р=0,002) withn.s. differences between groups 2 and 3. Proximal venous thrombosis: 5,0 % (2,2–11,2 %) in group 1 and 0 % in groups 2 and 3 (р=0,033). For pulmonary embolism no differences were found. The rate of big hemorrhages was: 4,0 % (1,6–9,8 %) in group 1 and 6,0 % (2,8–12,5 %) in group 2 (n.s.) and 26,5 % (14,6–43,1 %) in group 3 (р<0,001, р=0,003in compare with group 1 and 2).