Treatment of pelvic and acetabular fractures with variable dose heparin for the prevention of pulmonary embolus.

The incidence of pulmonary embolus in patients with pelvic and acetabular fractures treated with variable dose heparin as prophylaxis to pulmonary embolus

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12614000663651

Enrollment

369

Registered

2014-06-25

Start date

1987-08-07

Completion date

2007-06-10

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

This was a prospective study of 369 consecutive patients referred to a single surgeon for treatment of pelvic and acetabular fractures over a 20 year period. All patients were treated with chemoprophylaxis using unfractionated heparin, according to a sliding scale, at an ‘antithrombotic’ dose. Treatment was withheld for 48 hours post-injury and 48 hours post-operatively, due to the risk of bleeding. Patients were fully anticoagulated with warfarin 7 days post-operatively when the risk of secondary bleeding was over. Patients with clinical evidence of pulmonary embolus (PE) were investigated with ventilation-perfusion lung scans early in the study and CT angiography or MRI angiography when those investigations became available. Seven patients developed PE (1.9%). There was 1 fatal PE (0.3%) CONCLUSION: Variable dose unfractionated heparin followed by warfarin offers excellent protection against PE compared to published results of fixed dose regimens using fractionated heparin or unfractionated heparin in patients with pelvic and acetabular fractures.

Interventions

Variable dose unfractionated heparin, commencing 48 post injury, or post surgery, administered subcutaneously 8 hourly, according to a sliding scale based on APTT: <24 +1000 units 24-28 +500 units 29-32 No change 33-37 - 500 units >37 - 1000 units Heparin ceased 8 hours pre-operatively. Heparin ceased one week post-operatively, once patient warfarinised. Patients observed for any clinical evidence of pulmonary embolism, then confirmed with investigations (ventilation-pe

Eligibility

Sex/Gender

All

Age

16 Years to No maximum

Healthy volunteers

Inclusion criteria

Patients referred for treatments of pelvic and acetabular fractures and treated with variable dose unfractionated heparin as prophylaxis to pulmonary embolus

Exclusion criteria

Patients referred for treatment of pelvic and acetabular fractures and commenced on treatment with fixed dose regimens of fractionated or unfractionated heparin as prophylaxis to pulmonary embolus

Outcome results