Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393

• Published in: The Lancet (British edition) Vol. 347; no. 9002; pp. 635 - 639
• Main Authors: Eriksson, B.I, Kälebo, P, Zachrisson, B, Ekman, S, Bach, D, Close, P
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 09.03.1996; Lancet
• Subjects: Aged; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Confounding Factors (Epidemiology); Double-Blind Method; Female; Follow-Up Studies; Heparin - administration & dosage; Heparin - therapeutic use; Hip Prosthesis; Hirudin Therapy; Hirudins - administration & dosage; Hirudins - analogs & derivatives; Humans; Male; Medical sciences; Partial Thromboplastin Time; Pharmacology. Drug treatments; Postoperative Complications - prevention & control; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; Thromboembolism - prevention & control; Thrombophlebitis - prevention & control; Human; Prosthesis; Treatment efficiency; Diseases of the osteoarticular system; Cardiovascular disease; Anticoagulant; Thrombosis; Hip; Venous disease; Vascular disease; Prevention; Chemotherapy; Orthopedic surgery; Complication; Inhibitor; Deep vein; Recombinant protein
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(96)91200-3

Summary Background The frequency of thromboembolism after major orthopaedic surgery continues to be high despite prophylaxis. New agents such as CGP 39393, a recombinant form of hirudin, may be more effective than existing therapies. Methods In this double-blind, multicentre, European study the efficacy of three doses of CGP 39393, in comparison with unfractionated heparin, were examined in 1119 patients undergoing elective hip surgery. Patients were randomly allocated to receive by subcutaneous injection either 10, 15, or 20 mg of CGP 39393 twice daily or 5000 IU of heparin three times daily. All treatments were started just before surgery and continued for 8-11 days, until bilateral venography was performed. Findings The occurrence of thromboembolism was significantly reduced in patients treated with CGP 39393 compared to heparin. The frequency of deep-vein thrombosis was 34·2% in the heparin group as compared to 23·9% (p=0·0113), 18·4% (p=0·0003), and 17·7% (p=0·0001) in the 10 mg, 15 mg, and 20 mg CGP 39393 groups, respectively. At all dose levels, CGP 39393 was more effective than heparin in preventing proximal deep-vein thrombosis. The frequency of proximal thrombosis was 19·6% in the heparin group as compared to 8·5% (p<0·001), 3·1% (p<0·001), and 2·4% (p<0·001) in the 10 mg, 15 mg, and 20 mg CGP 39393 groups, respectively. All treatments were well tolerated. Interpretation This study indicates that specific inhibition of thrombin by prophylactic CGP 39393 significantly reduces thromboembolic complications in patients undergoing total hip replacement.