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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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Correspondence to S. A. Nillius.

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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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Key words

  • Deep vein thrombosis
  • Pulmonary embolism
  • Total hip replacement
  • Preoperative haemodilution
  • Dextran 70