Titre du document / Document title

Prevention of major venous thromboembolism following total hip or knee replacement : a randomized comparison of low-molecular-weight heparin with unfractionated heparin (ECHOS Trial)

Auteur(s) / Author(s)

ECHOS Trial Group
HAAS S. ⁽¹⁾ ; BREYER H. G. ⁽²⁾ ; BACHER H. P. ⁽³⁾ ; FAREED J. ⁽⁴⁾ ; MISSELWITZ F. ⁽⁵⁾ ; VICTOR N. ⁽⁶⁾ ; WEBER J. ⁽⁷⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Institute for Experimental Oncology and Therapy Research, Technical University of Munich, Munich, ALLEMAGNE
⁽²⁾ Sankt -Gertrauden -Krankenhaus, Berlin, ALLEMAGNE
⁽³⁾ Abbott Laboratories, Global Pharmaceutical Research and Development, Abbott Park, IL, ETATS-UNIS
⁽⁴⁾ Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, ETATS-UNIS
⁽⁵⁾ Abbott GmbH & Co KG Deutschland, Heidelberg, ALLEMAGNE
⁽⁶⁾ Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, ALLEMAGNE
⁽⁷⁾ Dr. Guth Clinic, Hamburg, ALLEMAGNE

Résumé / Abstract

Aim. Venous thromboembolism remains a frequent complication after total hip or knee replacement surgery despite routine prophylaxis. However, the ability of pharmacologic thromboprophylaxis to prevent major venous thromboembolism, defined as proximal deep vein thrombosis, and/or pulmonary embolism, and/or death, has not been previously validated. Methods. In a double-blind randomized study, 2018 patients, undergoing either total hip or knee replacement surgery, were allocated to receive subcutaneous preoperative reviparin (4 200 anti Xa IU) once daily or 7 500 IU unfractionated heparin twice daily, for a minimum of 11 days. The primary efficacy outcome was major venous thromboembolism, defined as the composite of venographically confirmed proximal deep vein thrombosis, and/or symptomatic pulmonary embolism and death, recorded up to day 14. Results. The primary efficacy outcome was assessed in 1 628 patients and demonstrated a significant reduction in the reviparin group (3.4% [28 of 813 patients] compared with unfractionated heparin (5.5% [45 of 815]) (odds ratio, 0.61; 95% confidence interval, 0.38 to 0.99, P=0.04) by day 11 to 14. A significant reduction in venous thromboembolism was maintained up to 6-8 weeks (3.4% [28 of 813 reviparin patients] versus 5.6% [46 of 815 unfractionated heparin patients]) (odds ratio, 0.6; 95% confidence interval, 0.37 to 0.97, P=0.03). Major bleeding events occurred in 9 reviparintreated patients (0.9%) and in 12 unfractionated heparin-treated patients (1.2%). Conclusions. Prophylaxis with reviparin significantly reduces the risk of major venous thromboembolism compared with unfractionated heparin in patients undergoing elective hip or knee replacement without increasing the risk of bleeding.

Revue / Journal Title

International angiology   ISSN 0392-9590 

Source / Source

2006, vol. 25, n^o4, pp. 335-342 [8 page(s) (article)] (35 ref.)

Langue / Language

Anglais

Editeur / Publisher

Minerva Medica, Torino, ITALIE  (1982) (Revue)

Mots-clés anglais / English Keywords

Venous disease ; Vascular disease ; Anticoagulant ; Dalteparin sodium ; Low molecular weight heparin ; Comparative study ; Knee ; Hip ; Prevention ; Embolism ; Deep vein thrombosis ; Venous thrombosis ; Thromboembolism ; Cardiovascular disease ;

Mots-clés français / French Keywords

Veine pathologie ; Vaisseau sanguin pathologie ; Anticoagulant ; Daltéparine sodique ; Héparine bas poids moléculaire ; Etude comparative ; Genou ; Hanche ; Prévention ; Embolie ; Thrombose profonde ; Thrombose veineuse ; Thromboembolie ; Appareil circulatoire pathologie ;

Mots-clés espagnols / Spanish Keywords

Vena patología ; Vaso sanguíneo patología ; Anticoagulante ; Dalteparina sódica ; Heparina bajo peso molecular ; Estudio comparativo ; Rodilla ; Cadera ; Prevención ; Embolia ; Trombosis venosa profunda ; Trombosis venosa ; Tromboembolia ; Aparato circulatorio patología ;

Mots-clés d'auteur / Author Keywords

Thromboembolism, prevention and control ; Heparin, low-molecular-weight ; Reviparin ; Arthroplasty, replacement, hip ; Arthroplasty, replacement, knee ;

Localisation / Location

INIST-CNRS, Cote INIST : 19982, 35400015997027.0010