Abstract
Venous thromboembolism is a major cause of mortality and morbidity in patients undergoing
orthopedic surgery. In these patients systemic prophylaxis with anticoagulants appears
to be the most effective approach to reduce venous thromboembolic events. Low-molecular-weight
heparins (LMWHs) are the prophylactic agents of choice in patients undergoing elective
hip replacement. However, their use is still associated with a 15% incidence of deep
vein thrombosis (DVT); hence, there is a need for potentially more effective agents.
Among these, hirudin and other selective thrombin inhibitors have recently been evaluated.
The main pharmacologic properties of recombinant hirudin and the clinical trials carried
out with this agent in the prevention of DVT in patients undergoing elective hip replacement
are reviewed in this article. Overall, the results of these clinical trials are quite
promising; they actually indicate that a b.i.d. subcutaneous injection of 15 or 20
mg of recombinant hirudin is an effective and safe prophylactic approach. Hirudin
was more effective than unfractionated heparin, given at a low fixed dose, in two
clinical trials and of a LMWH in one clinical trial. However, further studies are
required to define the role of recombinant hirudin in the prevention of venous thromboembolism
in orthopedic surgery patients.
Keywords:
Recombinant hirudin - venous thromboembolism - deep vein thrombosis - orthopedic surgery
