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October 15, 1973

Thromboembolism After Hip Reconstruction

Author Affiliations

The Mount Vernon Hospital Mount Vernon, NY

JAMA. 1973;226(3):356. doi:10.1001/jama.1973.03230030068033

To the Editor.—  I was sorry to see the result reported by Evarts and Alfidi in The Journal (225:515, 1973) on heparin prophylaxis of total hip reconstruction. I note that they have used Mr. Kakkar's program and not the one advocated by me.1 His is a dangerous modification of my program and has created difficulties, as admitted by Mr. Kakkar2 and by Mr. Charnley. Furthermore, Mr. Charnley has told me "we know that dextran doesn't work." I, on the other hand, guided by the findings of the pulmonary megakaryocytes and heparin controlled by the Dale and Laidlaw coagulometer, have experienced little difficulty. With my program giving 10,000 units of aqueous heparin subcutaneously the midnight before surgery and continuing postoperative small doses every six hours, not for just five to seven days as Mr. Kakkar recommends but until full reactivation or discharge, we have not had problems of hemorrhage