Summary
Dermatan sulphate catalyses thrombin inhibition by heparin cofactor II; it has a lower
haemorrhagic to antithrombotic ratio than that of heparin in animal models. Consecutive
patients aged forty years or more, electively undergoing total hip replacement under
general anaesthesia, were randomly allocated to one of three dosage regimens of dermatan
sulphate (MF701, Mediolanum Farmaceutici) given intramuscularly. These were 200 mg
once daily (n = 50), 200 mg twice daily (n = 52) and 300 mg twice daily (n = 51),
administered from twenty-four hours pre-operatively until the tenth postoperative
day. The overall incidence of DVT assessed by bilateral venography was 53%, 51% and
34% respectively (Chi-square test for trend p = 0.06). The incidence of major proximal
DVT was 10.6%, 8.5% and 2.1% respectively. Pulmonary embolism (PE) and bleeding were
assessed in all 153 patients. There was one case of PE in each dose group. The incidence
of bleeding episodes, volume of blood lost and blood transfusion requirements were
low and showed no increase with increasing dose. The patients were followed up 4-8
weeks after discharge.
We conclude that the two lower doses were subtherapeutic in this population, however
dermatan sulphate given 300 mg twice daily, proved to be efficacious with an incidence
of proximal major DVT of 2.1% and a low incidence of bleeding complications. A trial
of dermatan sulphate 300 mg twice daily compared to standard prophylactic agents is
needed.
