The Preliminary Investigation Of The Using Timing Of Prophylactic Anticoagulant In Elderly Hip Fracture With Total Hip Arthroplasty

Objective: To explore the rational medication time of low molecular weightheparin(LMWH) in preventing deep vein thrombosis(DVT) among elders whounderwent timing selective total hip arthroplasty(THA) due to hip fracture.Methods:80patients with hip fracture from June of2010to October of2011inour department was included in this study. All of them are older than60years old,among them26are male,54female, age from60-87, average age was74.3years old.48patient were diagnosed as femoral neck fracture,12patients were diagnosed as femoralintertrochanteric fracture, all the patient underwent unilateral total hip arthroplasty. Allthe patient were randomly divided into two groups, group Ⅰ(medication12hoursbefore surgery) and group II(medication12-24hours after surgery group),40in eachgroup. In groupⅠ physical method(lower limb isometric contraction, active or passiveankle activity, partial massage in lower limb) were used and low weight heparin wasused12hours before surgery. In group II physical method was used and heparin wasstarted to use12-24hours after surgery.Monitored blood routine when they werehospitalized,preoperative,2days after operation and7days after operation. Drainagequantity, hidden blood loss, the total blood loss were recorded. Doppler ultrasonic testof low limb vessel were done in all the patients3months after surgery. The incidence ofDVT in each group was compared to evaluate the benefit and effectiveness.Results: Total blood loss and hidden blood loss in group1were1639.88ml and474.75ml, in group2were1250.00ml and371.20ml, there was significant differencebetween two groups(P<0.05).4patient(incidence10.0%,4/40) had DVT in group1,and6patient(incidence15.0%6/40), there was no statistical difference between twogroups(P>0.05). Conclusion:Preventive usage of low molecular weight heparin can reduced thetotal blood loss and hidden blood loss in elder patients who underwent total hiparthoplasty due to hip fracture, but it can not reduce the incidence of DVT, thereforestart to use it12-24hours after surgery is more reliable.