The efficacy of two antithrombotic regimens, combined dextran and
aspirin and combined dextran and warfarin, was analyzed by comparing the
incidence of thromboembolism following total hip replacement in two groups
of similar patients. Of the 427 who received dextran and aspirin, 7 per
cent had thromboembolic complications, including one case of fatal
pulmonary embolus and one case of recurrent emboli that required vena caval
ligation, and 15 per cent had wound-healing complications. Of the 197
patients who received dextran and warfarin, 5 per cent had thromboembolism
and 24 per cent had wound healing complications. Although both prophylactic
regimens seemed effective, dextran and aspirin appeared less effective in
reducing thromboembolic complications than dextran and warfarin, but there
were fewer wound complications in that group. One-fourth of the patients on
dextran-warfarin were not adequately anticoagulated despite close
supervision. In forty-five patients with a history of thromboembolism who
were excluded from the study and analyzed separately, warfarin alone and
the two described regimens were equally ineffective in preventing
thromboembolism, and the incidence of thromboembolic complications was
high. Dextran-aspirin and dextran-warfarin appear to be satisfactory and
relatively simple methods of thromboembolic prophylaxis.