A Synthetic Pentasaccharide for the Prevention of Deep-Vein Thrombosis

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Abstract
Turpie et al. (March 1 issue)1 report the findings of a rigorously performed double-blind, randomized trial comparing a synthetic pentasaccharide (Org31540/SR90107A) and a low-molecular-weight heparin (enoxaparin) in patients undergoing total hip replacement. The patients were randomly assigned to receive one of five daily doses of the pentasaccharide beginning 6 hours postoperatively (range, 4 to 8) or enoxaparin beginning 12 to 24 hours postoperatively. Two studies2,3 evaluated the effect of prophylaxis with low-molecular-weight heparin administered in close proximity to surgery, either within two hours before surgery or six hours after surgery, in patients undergoing elective hip surgery and found that low-molecular-weight heparin was more effective than oral anticoagulants. In contrast, the effectiveness of therapy with low-molecular-weight heparin begun 12 hours preoperatively 4 or 12 to 24 hours postoperatively5 was similar rather than superior to that of oral anticoagulants. The timing of prophylaxis is crucial; antithrombotic prophylaxis administered in close proximity to surgery is more effective than delayed prophylaxis.