Low-molecular-weight heparin vs. conventional low-dose heparin for the prevention of venous thromboembolism in patients with hip fracture (1989)


Prophylaxis for thromboembolic complications in patients admitted for surgery because of hip fracture

Close this section


To compare the efficacy of a LMWH with that of standard low-dose heparin in the prevention of VTE in patients with hip fracture

Close this section

Trial design

Prospective, randomized, double-blind study
Active treatment: LMWH (2165 LMWH, Kabi Vitrum AG) 2500 IU s.c. 2 hours before surgery, thereafter 5000 IU s.c. once daily for 9 days; heparin placebo s.c. twice daily (n=46)
Control treatment: UFH 5000 IU s.c. 2 hours before surgery, thereafter at 8-hours intervals for 9 days (n=44)

Close this section


Primary efficacy endpoint: DVT and PE during the postoperative period
Primary safety endpoints: bleeding, red cell transfusion requirement, hematocrit level

Close this section

Trial participants

90 consecutive patients (>40 years of age) who were admitted because of hip fracture and were operated on the day of fracture; 86 patients were evaluable

Close this section


Efficacy outcome: 6 of 44 patients (13.6%) of the LMWH group developed postoperative PE, but none of the 42 patients in the UFH group; the difference was statistically significant. Indeterminate lung scans were detected in 8 patients (18.2%) assigned to LMWH and 6 patients (13.6%) given UFH. DVT occurred in significantly more patients given LMWH than in UFH-treated patients (31.8% vs. 14.3%). The rates for proximal vein thrombosis were 27.3% and 11.9%, respectively
Safety outcome: Intestinal bleeding complications occurred in 2 patients (4.5%) receiving LMWH and in 1 patient (2.4%) assigned to UFH. 2 patients in each group developed a wound hematoma (4.4% and 4.8%, respectively. Red cell transfusion requirements were larger in the LMWH group (40 units) than in the UFH group (20 units). The hematocrit levels on day 4 after surgery were similar in both groups. 2 patients in the LMWH group an 3 in the UFH group died (4.5% vs. 7.1%)


Close this section


Efficacy: In patients undergoing surgery because of hip fracture, low-dose standard heparin was more effective in preventing postoperative PE and DVT than a single daily injection of LMWH, in the dosage used
Safety: No significant difference was observed between both treatment groups in terms of bleeding, fall in postoperative hemoglobin, and the frequency of wound hematoma

Close this section


Monreal M, Lafoz E, Navarro A, Granero X, Caja V, Caceres E, Salvador R, Ruiz J. A prospective double-blind trial of a low molecular weight heparin once daily compared with conventional low-dose heparin three times daily to prevent pulmonary embolism and venous thrombosis in patients with hip fracture. J Trauma 1989;29:873-875

Close this section

Corresponding author

Prof. M. Monreal, Servicio de Medicina Interna, Hospital de Barcelona “Germans Trias i Pujol”, Ctra. Del Canyer s/n, Badalona (Barcelona), Spain

Close this section

Back To List

Recommend pageBack to top