low dose heparin therapy

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80 Injury, 10, 80-82 Printed m Great Britain Abstracts Thromboembolism Low dose heparin therapy This is a reappraisal of the results published 18 months previously of a trial carried out in several centres. The reappraisal was necessary because it had come to light that results from one centre were not reliable. When the results from that centre were excluded, the general conclusion remained unchanged but the case for using subcutaneous injections of heparin before and after operation to prevent thromboembolism was strengthened. About two-thirds of the patlents who died in each group were subjected to necropsy, from which it was found that 15 of the control group but none of the heparin group had died of massive pulmonary embohsm. The significant difference in thrombosis of the deep veins and the conclusions regarding bleeding during and after operation in the two groups were unaltered. Kakkar V. V., Corrigan T. P., Fossard D. P. et al. (1977) Prevention of fatal post-operative pulmonary embolism by low doses of heparln. Lancet 1, 567. Venous thrombosis in acute spinal cord paralysis Pulmonary embolism is known to be a significant cause of death in the first few weeks after acute spinal cord paralysis. Nine out of I0 patients with acute spinal cord paralysis, investigated with labelled fibrinogen, phlebography and venogram studies, showed evidence of deep vein thrombosis. Eight of the 10 patients also developed a positive labelled fibrinogen test after a surgical procedure. Steps should be taken to prevent deep veln throm- bosis and pulmonary embolism in patients with acute spinal cord paralysis. Brach B. B., Moser K. M., Cedar L. et al. (1977) Venous thrombosis in acute spinal cord paralysis. J. Trauma 17, 289. Intravenous lignocaine after hip surgery In 14 control patients, 78 per cent were found to have developed deep venous thrombosis, 57 per cent in the thigh. Fourteen other patients chosen at random from those that had undergone operations on their hips were given lignoeaine for 6 days after operation and only 2 developed thrombosis in the calves. Fourteen more consecutive patients were similarly treated and 4 developed thrombi in the calf. None of these 28 developed femoral thrombi but during the 7 days after lignocaine therapy was stopped 53 per cent developed thrombosis, 21 per cent in the thigh. Two per cent lignocaine (! mg/kg) was given intravenously over 5 rain before the operation and thereafter 2 mg/min were given continuously in 5 per cent glucose solution for 6 days and the effects studied by means of thermography and phlebography. The lignocaine had no effect on coagulation, fibrinolysls or the amount of bleeding during and after operation. Cooke E. D, Bowcock S. A, Lloyd M J. et al. (1977) Intravenous llgnocaine in prevention of deep venous thrombosis after elective hip surgery. Lancet 2, 797. Recreational injuries Low back injury One hundred men and women who had been referred to the Sports Clinic at Guy's Hospital with low back pain were studied. There were 87 men and 13 women. Thirty-seven injured their backs in training, weight training being the single most frequent cause of injury with a rotational element. Eighty-five players had had to give up their sport partly or completely until seen in the clinic. This might be as long as 5 months in some cases. Spondylolysis was found in 18 patients Sixty-five per cent lost time from work or study as a result of their back injury. Ten patients needed admission to hospital. The authors highlight the lack of formal supervision of training methods, the lack of rehabilitation facilities in general and the high incidence of spondy- lolysis. Billings R. A., Burry H. C. and Jones R. (1977) Low back injury in sport. Rheum. Rehabil. 16, 231. Horse-riding injuries In this one-year prospective study 174 patients with riding injuries were investigated. Two-thirds of all the patients were children who suffered relatively minor injuries and were riding again within a month. The majority of accidents occurred in those who had been riding for more than a year. Two of the observations made in this article are of practical interest:

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Page 1: Low dose heparin therapy

80 Injury, 10, 80-82 Printed m Great Britain

Abstracts

T h r o m b o e m b o l i s m Low dose heparin therapy This is a reappraisal of the results published 18 months previously of a trial carried out in several centres. The reappraisal was necessary because it had come to light that results from one centre were not reliable. When the results from that centre were excluded, the general conclusion remained unchanged but the case for using subcutaneous injections of heparin before and after operation to prevent thromboembolism was strengthened. About two-thirds of the patlents who died in each group were subjected to necropsy, from which it was found that 15 of the control group but none of the heparin group had died of massive pulmonary embohsm. The significant difference in thrombosis of the deep veins and the conclusions regarding bleeding during and after operation in the two groups were unaltered.

Kakkar V. V., Corrigan T. P., Fossard D. P. et al. (1977) Prevention of fatal post-operative pulmonary embolism by low doses of heparln. Lancet 1, 567.

Venous thrombosis in acute spinal cord paralysis Pulmonary embolism is known to be a significant cause of death in the first few weeks after acute spinal cord paralysis. Nine out of I0 patients with acute spinal cord paralysis, investigated with labelled fibrinogen, phlebography and venogram studies, showed evidence of deep vein thrombosis. Eight of the 10 patients also developed a positive labelled fibrinogen test after a surgical procedure.

Steps should be taken to prevent deep veln throm- bosis and pulmonary embolism in patients with acute spinal cord paralysis.

Brach B. B., Moser K. M., Cedar L. et al. (1977) Venous thrombosis in acute spinal cord paralysis. J. Trauma 17, 289.

Intravenous lignocaine after hip surgery In 14 control patients, 78 per cent were found to have developed deep venous thrombosis, 57 per cent in the thigh. Fourteen other patients chosen at random from those that had undergone operations on their hips were given lignoeaine for 6 days after operation and only 2 developed thrombosis in the calves. Fourteen more consecutive patients were similarly treated and

4 developed thrombi in the calf. None of these 28 developed femoral thrombi but during the 7 days after lignocaine therapy was stopped 53 per cent developed thrombosis, 21 per cent in the thigh.

Two per cent lignocaine (! mg/kg) was given intravenously over 5 rain before the operation and thereafter 2 mg/min were given continuously in 5 per cent glucose solution for 6 days and the effects studied by means of thermography and phlebography. The lignocaine had no effect on coagulation, fibrinolysls or the amount of bleeding during and after operation.

Cooke E. D , Bowcock S. A , Lloyd M J. et al. (1977) Intravenous llgnocaine in prevention of deep venous thrombosis after elective hip surgery. Lancet 2, 797.

R e c r e a t i o n a l in jur ies Low back injury One hundred men and women who had been referred to the Sports Clinic at Guy's Hospital with low back pain were studied. There were 87 men and 13 women.

Thirty-seven injured their backs in training, weight training being the single most frequent cause of injury with a rotational element. Eighty-five players had had to give up their sport partly or completely until seen in the clinic. This might be as long as 5 months in some cases.

Spondylolysis was found in 18 patients Sixty-five per cent lost time from work or study as a result of their back injury. Ten patients needed admission to hospital.

The authors highlight the lack of formal supervision of training methods, the lack of rehabilitation facilities in general and the high incidence of spondy- lolysis.

Billings R. A., Burry H. C. and Jones R. (1977) Low back injury in sport. Rheum. Rehabil. 16, 231.

Horse-riding injuries In this one-year prospective study 174 patients with riding injuries were investigated. Two-thirds of all the patients were children who suffered relatively minor injuries and were riding again within a month. The majority of accidents occurred in those who had been riding for more than a year.

Two of the observations made in this article are of practical interest: