[The value of dextran 70 in the prevention of thromboembolism in general surgery, orthopedics, urology and gynecology. A review of the literature]

Abstract

28 prospective, controlled, randomised studies on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in surgical patients on dextran 70 prophylaxis are analysed. In all patients the diagnosis had been established by objective methods (fibrinogen test, phlebography, autopsy). In patients undergoing hip surgery (11 studies, mainly fractures of the upper end of the femur) the reduction in the number of DVT under dextran prophylaxis is the more evident the longer after operation phlebography is carried out. Coumarin and dextran prevention are equally effective. In 3 studies where diagnosis by the fibrinogen test was established during the first postoperative week only, no significant effect of dextran can be shown; there is no difference between the effect of dextran, coumarin or small doses of subcutaneous heparin. The effectiveness of dextran prophylaxis in reducing the DVT rate in general surgery (4 papers) is not clear, though 7 studies show that the number of fatal PE is reduced more than fivefold (p less than 0.0005). In patients on dextran prophylaxis, the incidence of DVT is equal to that in patients on coumarin prophylaxis before major gynecological surgery (4 papers). On postoperative initiation coumarin is significantly less effective than dextran. 2 further studies show that dextran is significantly effective as compared to controls and that there is no difference between dextran and heparin prophylaxis. Out of 1932 control patients 36 died of fatal PE verified at autopsy. Only 8 PE were seen in the group of 2011 patients receiving dextran prophylaxis (p less than 0.005). The effectiveness of dextran 70 corresponds to that of small doses of subcutaneous heparin. Dextran prevention is more effective in women than in men. Dextran prophylaxis is simple to carry out, has few contraindications, only rarely causes complications and is already effective during operation.