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Preoperative normovolaemic haemodilution with dextran 70 as a thromboembolic prophylaxis in total hip replacement

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Summary

The effect of preoperative normovolaemic haemodilution with dextran 70 in 57 patients undergoing total hip replacement for osteoarthritis, was evaluated with respect to the production of thrombosis and pulmonary embolism. The patients were randomly allocated to one group undergoing preoperative haemodilution and one control group receiving 500 ml dextran 70 during operation and again on the second postoperative day. Before operation blood was replaced by dextran 70 to lower the hematocrit to between 25 and 30. The blood drained from the patients was used to replace blood lost at operation.

Between 10 and 14 days after operation the patients were examined by perfusion lung scan, chest radiography and bilateral phlebography. Twelve patients also had 133Xe ventilation scans. The incidence of deep vein thrombosis in the two groups did not differ significantly. Pulmonary embolism was significantly decreased in the preoperative haemodilution group. One patient in the control group had clinical symptoms of, and died from, pulmonary embolism.

Résumé

L'effet antithrombosant d'une hémodilution pré-opératoire par le dextran 70 at été étudié chez 57 malades qui ont subi une arthroplastie totale de hanche pour coxarthrose. Les malades ont été distribués par randomisation en deux groupes; dans l'un, ils ont été soumis au traitement: hémodilution pré-opératoire et dans l'autre, groupe de contrôle, ils ont reçu 500 ml de dextran 70 pendant l'opération et au second jour post-opératoire. L'hémodilution pré-opératoire a été réalisée en remplaçant le sang par le dextran pour réduire l'hématocrite à 25–30. Le sang prélevé a été employé pour compenser l'hémorragie per-opératoire.

Dix à 14 jours après l'opération les malades ont été examinés par scintigraphie pulmonaire, radiographie pulmonaire et phlébographie bilatérale. Douze malades ont aussi subi une scintigraphie au Xenon 133. Il n'y a pas eu de différence significative entre les deux groupes en ce qui concerne le développement de thrombose des veines profondes. Par contre le nombre d'embolie pulmonaire a été réduit de façon significative dans le groupe qui a subi l'hémodilution pré-opératoire. Un malade du groupe de contrôle présenta des symptômes cliniques d'embolie pulmonaire et en mourut.

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References

  1. Åberg, M.: On effect of dextran on lysability and structure of ex vivo thrombi, platelet function and factor VIII. Thesis, University of Lund, Medical Academy, Malmö 1978

    Google Scholar 

  2. Ahlberg, Å.: Trombosprofylax med Macrodex i ett collumfrakturmaterial, pp. 89–98. Studentlitteratur, Lund 1969

    Google Scholar 

  3. Ahlberg, Å., Nillius, A., Rosberg, B., Wulff, K.: Preoperative normovolaemic haemodilution in total hip arthroplasty — A clinical study. Acta Chir. Scand. 143, 407–411 (1977)

    Google Scholar 

  4. Allgood, R. J., Cook, J. H., Weedn, R. J., Speed, H. K., Witcomb, W. H., Greenfield, L. J.: Prospective analysis of pulmonary embolism in the postoperative patient. Surgery 68, 116–122 (1970)

    Google Scholar 

  5. Allison, P. R., Dunnill, M. S., Marshal, R.: Pulmonary embolism. Thorax 15, 273–283 (1960)

    Google Scholar 

  6. Browse, N. L., Clemenson, G., Bateman, N. T., Gaunt, J. I., Croft, D. N.: Effect of intravenous dextran 70 and pneumatic leg compression on incidence of postoperative pulmonary embolism. Br. Med. J. 2, 1281–1284 (1976)

    Google Scholar 

  7. Coventry, M. B., Beckenbaugh, R. D., Nolan, D. R., Ilstrup, D. M.: 2012 total hip arthroplasties: A study of postoperative course and early complications. J. Bone Joint Surg. [Am.] 56, 272–284 (1974)

    Google Scholar 

  8. Evarts, M., Feil, J.: Prevention of thromboembolic disease after elective surgery of the hip. J. Bone Joint Surg. [Am.] 53, 1271–1280 (1971)

    Google Scholar 

  9. Flanc, C., Kakkar, V. V., Clarke, M. B.: The detection of venous thrombosis of the legs using 125I-labelled fibrinogen. Br. J. Surg. 55, 742–747 (1968)

    Google Scholar 

  10. Gilday, D. L., James, A. E. Jr.: Lung scan patterns in pulmonary embolism versus those in congestive heart failure and emphysema. Am. J. Roentgenol. 15, 739 (1972)

    Google Scholar 

  11. Gruber, U. F., Bergentz, S.-E.: The antithrombotic effect of dextran. J. Surg. Res. 6, 379–382 (1966)

    Google Scholar 

  12. Gruber, U. F.: Dextran and the prevention of postoperative thromboembolic complications. Surg. Clin. North Am. 55, 679–696 (1975)

    Google Scholar 

  13. Gruber, U. F., Sturm, V., Rem, J., Schaub, N., Rittmann, W. W.: The present state of prevention of postoperative thromboembolic complications. In: Intentional Hemodilution. Bibl. Haematol. 41, 98–124 (1975)

    Google Scholar 

  14. Hume, M., Turner, R. H., Kuriakose, T. X., Surprenant, J.: Venous thrombosis after total hip replacement. J. Bone Joint Surg. [Am.] 58, 933–939 (1976)

    Google Scholar 

  15. Jansen, H.: Postoperative thromboembolism and its prevention with 500 ml dextran given during operation. Acta Chir. Scand. (Suppl.) 427 (1972)

  16. Johnson, R., Green, J. H., Charnley, J.: Pulmonary embolism following the Charnley total hip replacement and its prophylaxis. Centre for hip surgery, Wrightington Hospital: Internal publication No. 64 (1976)

  17. Kline, A., Hughes, L. E., Campbell, H., Williams, A., Zlosnick, J., Leach, K. G.: Dextran 70 in prophylaxis of thromboembolic disease after surgery. A clinically oriented randomized double-blind trial. Br. Med. J. 2, 109–112 (1975)

    Google Scholar 

  18. Lamke, L.-O., Liljedahl, S.-O.: Plasma volume, changes after infusion of various plasma expanders. Resuscitation 5, 93–102 (1976)

    Google Scholar 

  19. Lahnborg, G., Bergström, K., Friman, L., Lagergren, H.: Effect of low-dose heparin on incidence of postoperative pulmonary embolism detected by photoscanning. Lancet I, 329–331 (1974)

    Google Scholar 

  20. McIntyre, I. M. C., Ruckley, C. V.: Pulmonary embolism — A clinical and autopsy study. Scott. Med. J. 19, 20–24 (1974)

    Google Scholar 

  21. McNeil, B. J., Holman, B. L., Adelstein, S. J.: The scintigraphic definition of pulmonary embolism. JAMA 227, 753–756 (1974)

    Google Scholar 

  22. Messmer, K., Sunder-Plassman, L.: Hemodilution. Progr. Surg. 13, 208 (1974)

    Google Scholar 

  23. Messmer, K.: Hemodilution. Surg. Clin. North Am. 55, 659–678 (1975)

    Google Scholar 

  24. Moses, D. C., Silver, T. M., Bookstein, J. J.: The complementary roles of chest radiography, lung scanning and selective pulmonary angiography in the diagnosis of pulmonary embolism. Circulation 49, 179–188 (1974)

    Google Scholar 

  25. Murphy, M. L., Dalrymple, G. V., Rivarola, C.: Silent pulmonary embolism in the elderly surgical patient. Geriatrics 27, 87–93 (1972)

    Google Scholar 

  26. Muzaffar, T. Z., Stalker, A. L., Bryce, W. A. J., Dhall, D. P.: Dextran and fibrin morphology. Nature 238, 288–290 (1972)

    Google Scholar 

  27. Nylander, G.: Venography of the lower extremities. In: Abrams: Angiography, 2nd ed., pp. 1251–1271. Boston: Little, Brown & Company 1971

    Google Scholar 

  28. Ring, P. A.: Total replacement of hip joint. J. Bone Joint Surg. [Br.] 56, 44–58 (1974)

    Google Scholar 

  29. Saldeen, T.: The microembolism syndrome and dextran. Acta Universitatis Upsalienses 3, 31–38 (1977)

    Google Scholar 

  30. Silver, D.: Pulmonary embolism. Prevention, detection and nonoperative management. Surg. Clin. North Am. 54, 1089–1106 (1974)

    Google Scholar 

  31. Stephenson, C. B. S., Wallace, J. C., Vaughan, J. V.: Dextran 70 in the prevention of postoperative deep vein thrombosis with observations on pulmonary embolism: Report on a pilot study. N. Z. Med. J. 77, 302–305 (1973)

    Google Scholar 

  32. Tangen, O., Wik, K. O., Almquist, I. A. M., Arfors, K. E., Hint, H. C.: Effects of dextran on the structure and plasmin-induced lysis of human fibrin. Thromb. Res. 1, 487–492 (1972)

    Google Scholar 

  33. Tow, D. E., Simon, A. L.: Comparison of lung scanning and pulmonary angiography in the detection and follow-up of pulmonary embolism: The urokinase — pulmonary embolism trial experience. Progr. Cardiovasc. Dis. 17, 239–245 (1975)

    Google Scholar 

  34. Wagner H. N. Jr., Strauss, H. W.: Radioactive tracers in the differential diagnosis of pulmonary embolism. Progr. Cardiovasc. Dis. 17, 271–282 (1975)

    Google Scholar 

  35. Walkley, J. W., Tillman, J., Bonnar, J.: The persistence of dextran 70 in blood plasma following its infusion, during surgery, for prophylaxis against thromboembolism. J. Pharm. Pharmacol. 28, 29–31 (1976)

    Google Scholar 

  36. Williams, O., Lyall, J., Vernon, M., Croft, D. N.: Ventilation — perfusion lung scanning for pulmonary emboli. Br. Med. J. 1, 600–602 (1974)

    Google Scholar 

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Authors and Affiliations

  1. Departments of Orthopaedic Surgery, Clinical Physiology and Anaesthesiology, Malmö General Hospital (University of Lund), S-214 01, Malmö, Sweden

    S. A. Nillius, A. Ahlberg, M. Arborelius Jr. & B. Rosberg

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  1. S. A. Nillius
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  2. A. Ahlberg
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  3. M. Arborelius Jr.
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  4. B. Rosberg
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Nillius, S.A., Ahlberg, A., Arborelius, M. et al. Preoperative normovolaemic haemodilution with dextran 70 as a thromboembolic prophylaxis in total hip replacement. International Orthopaedics 3, 197–202 (1979). https://doi.org/10.1007/BF00265712

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