The Clinical Impact Of Blood Loss With Low Molecular Weight Heparin Using In Total Joint Replacement

Artificial joint replacement (TJR) is the treatment of advanced arthritis,avascular necrosis of femoral head and the femoral neck facture in elderly people,which could remove pain,correct deformity,reconstruct the painless,stable and functional joints so that the life quality of the patients are improved. Lower extremity deep vein thrombo- sis (DVT) refers to the blood abnormal clotting in the venous cavity, blocking the venous cavity, leading to venous reflux disorder,which is a common complication in orthopedic inpatients especially in patients with joint replacement surgery, associated pulmonary embolism (PE) is the leading cause of death. With TJR in China rapidly growing, the prevention of DVT and PE has been emphasized increasingly. The use of low molecular weight heparin (LMWH) in the patients unwent artificial joint replacement has been widely accepted, its effect has been confirmed.For a long time,we think LMWH increase the patients'peroperative and postoperative bleeding volume less,the security of using low molecular weight heparin in TJR is high,the efficacy is reliable.But some studies in recent years have shown that it had increased the patients'bleeding volume in despite of it was safer than unfractionated heparin(UFH),and increased the operative risk. The past two years, the patients who used LMWH and the patients who not were compared in our hospital,we analysed them and computerd their bleeding volume in TJR,thus making out the relationship between using LMWH and bleeding volume in artificial joint replacement.Objective To explore the clinical impact of bleeding volume with low molecular weight heparin(LMWH) using in total knee arthroplasty(TKA) and total hip arthroplasty(THA).Methods 85 patients unwent unilateral primary arthroplasty were divided into experimental group and control group by stratified randomization. The experimental group(LMWH) has 39 case,including 16 male patients and 23 female patients who's average age was 69.3 years.In the experimental group there were 23 patients unwent THR and 16 patients unwent TKR.The contol group has 46 case,including 19 male patients and 27 female patients who's average age was 68.5 years.In the contol group (no LMWH),there were 29 patients under THR and 17 patients under TKR.All patients'coagulation were checked normal,no DVT was carried with them through low extremity venous ultrasound and color sonography checking and the patients did not have the use of other anti-clotting drugs.Blood routine examination was done preoperatively and 2-4h postoperatively,hematocrit(Hct) was recorded,all patients'sta- ture and weight were measured preoperatively,blood loss and incision drainage were recorded.Through hidden blood loss introducting,We calculated the total blood loss.So some comments on the security of application of LMWH were made by these.Results The amount of blood loss was 1694ml in THR of the experimental group,it was 1570ml in TKR; The amount of blood loss was 1336ml in THR of the control group,it was 1302ml in TKR. there were different between them.Conclusion LMWH using in TJR increase the patients'bleeding volume;So we ought to notice to add the bood volume when we used LMWH for preventing DVT in TJR.