Blanchard J, Meuwly JY, Leyvraz PF, Miron MJ, Bounameaux H,
Hoffmeyer P, Didier D, Schneider PA.
Prevention of deep-vein thrombosis after total knee replacement. Randomised
comparsion between a low-molecular-weight heparin (nadroparin) and mechanical
prophylaxis with a foot-pump system.
J Bone Joint Surg Br 1999 Jul;81(4):654-9

Hopital Orthopedique de la Suisse Romande, Lausanne, Switzerland.

The optimal regime of antithrombotic prophylaxis for patients undergoing total
knee arthroplasty (TKA) has not been established. Many surgeons employ
intermittent pneumatic compression while others use low-molecular-weight heparins
(LMWH) which were primarily developed for total hip arthroplasty. We compared the
efficacy and safety of these two techniques in a randomised study with blinded
assessment of the endpoint by phlebography. We randomised 130 patients, scheduled
for elective TKA, to receive one daily subcutaneous injection of nadroparin
calcium (dosage adapted to body-weight) or continuous intermittent pneumatic
compression of the foot by means of the arteriovenous impulse system. A total of
108 patients (60 in the LMWH group and 48 in the mechanical prophylaxis group)
had phlebography eight to 12 days after surgery. Of the 47 with deep-vein
thrombosis, 16 had received LMWH (26.7%, 95% CI 16.1 to 39.7) and 31, mechanical
prophylaxis (64.6%, 95% CI 49.5 to 77.8). The difference between the two groups
was highly significant (p < 0.001). Only one patient in the LMWH group had severe
bleeding. We conclude that one daily subcutaneous injection of calcium nadroparin
in a fixed, weight-adjusted dosage scheme is superior to intermittent pneumatic
compression of the foot for thromboprophylaxis after TKA. The LMWH scheme was
also safe.