Extract
The low-molecular-weight heparins are a group of agents widely used in the
prevention of deep-vein thrombosis and pulmonary embolism in orthopaedic
patients, especially those undergoing total joint replacement of the lower
extremity. They have been in clinical use for almost twenty years and have
proved to be at least as effective as other means of thrombosis
prevention1. The
American College of Chest Physicians has recommended them for routine use in
total hip replacement for the past ten years, as an alternative to warfarin
and adjusted-dose unfractionated
heparin2,3.
Their main advantages are that they can be used without laboratory monitoring
and they have a favorable therapeutic index (less risk of bleeding compared
with unfractionated heparin for a given antithrombotic
effect)4. Bleeding
and thrombocytopenia are, however, documented complications of the use of
low-molecular-weight
heparin5-9,
but, to our knowledge, cerebral hemorrhages secondary to thrombocytopenia have
not been reported in association with orthopaedic procedures. We report the
cases of two patients who had thrombocytopenia and cerebral complications
after routine treatment with low-molecular-weight heparin for thromboembolic
prevention following total hip replacement. Our patients or their families
were informed and consented that data concerning their cases would be
submitted for publication.