[Prevention of thrombosis with fraxiparin 0.3 after ambulatory surgery]

AIMS AND METHODOLOGY

Between September 1993 and January 1994, a post surveillance study involving 113 physicians in private practise was carried out to investigate the efficacy and safety of the low-molecular-weight heparin. Fraxiparin 0.3. The aim of the study was to obtain information about the usual prescription of approved drugs. In this case, the efficacy based on the incidence of thromboembolic events (deep vein thrombosis in the leg, pulmonary embolism) and tolerability on the basis of the recording of undesired adverse reactions were to be investigated in a large group of patients undergoing ambulatory operations.

RESULTS

Participants in the study comprised 1028 men and women aged between 13 and 93 years who, for the most part, underwent operations on the lower limbs with subsequent immobilization. As a preventive measure against thromboembolic complications, all patients received a daily subcutaneous injection of fraxiparin 0.3. The duration of the prophylaxis was determined by the physician on an individual basis and was 9 days on average. During the course of the drug monitoring, 12 cases of deep vein thrombosis of the leg (1.2%) and 2 pulmonary embolism (0.2%) occurred. Eight of the 14 patients with thromboembolic complications also had additional risk factors. In ten of these 14 cases, patients were younger than 40 years (average age of the overall group: 42.8 years). A noteworthy observation was the fact that in four cases, the venous thromboses in the leg occurred only after the last injection of heparin. The results confirm that preventive Fraxiparin 0.3 provides reliable protection against thromboembolic disease in patients undergoing ambulatory surgery. The low rate of undesired side-effects (1.3%) underscores the high level of tolerability of this drug.

[Prevention of thrombosis with fraxiparin 0.3 after arthroscopic interventions]

METHODS

During a drug monitoring 101 men and women between 13 and 67 years underwent arthroscopic interventions on the knee on an outpatient basis and received the low-molecular-weight heparin, Fraxiparin 0.3, as prophylaxis of thromboembolism. In general the drug was administered the day before operation, two hours prior to operation and for five to six days postoperatively as a single daily s.c. dose.

RESULTS

During the period of treatment, one patient developed a deep venous thrombosis of the leg; on completion of observation time four more cases of venous thrombosis of the leg occurred. In contrast, no pulmonary embolisms were observed. Fraxiparin 0.3 has proved to be very well tolerated, undesired side effects did not occur, and in no case was the preventive treatment interrupted.

Non-invasive studies of the extra-cranial cerebral arteries: indication for angiography and operation

During recent years, the risk involved in cerebral angiography has been considerably reduced. However, in our patient group this risk was still almost as high as that involved in operation. Non-invasive examination by means of the ultrasonic Doppler procedure has been improved with a resulting success rate of over 95%. Color coding stored in a computer program with the "Echoflow"-procedure allows for demonstration of the neck vessels giving an indication of the degree of stenosis. By this method, pictures of document quality are provided which can also be obtained by inexperienced examiners and interpreted more easily than curve registrations of the acoustic signals. In comparison with angiography, the Echoflow method was less sensitive than the conventional ultrasonic Doppler procedure especially in cases of low-degree stenosis of the internal carotid artery. Nevertheless, in 2.7% of the cases, a correct Echoflow diagnosis could be confirmed during operation where angiography had not shown the changes correctly. As the Echoflow procedure does not give sufficient information on intracranial pathology, we have so far dropped angiography in emergency cases only when establishing the indication for operation; however, in follow-up examinations this method is used exclusively instead of angiography.