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Thrombocytopenia and Intra-cerebral Complications Associated with Low-Molecular-Weight Heparin Treatment in Patients Undergoing Total Hip ReplacementA Report of Two Cases
Anastasios K. Lilikakis, MD1; Theodoros Papapolychroniou, MD2; Georgios Macheras, MD3; Emmanuel Michelinakis, MD4
1 67 Pratinou Street, 11634, Athens, Greece. E-mail address for A.K. Lilikakis: alilikakis@yahoo.com
2 41 Korytsas Street, 15669, Athens, Greece
3 18 Papadiamantopoulou Street, 11528, Athens, Greece
4 2 Sismanoglou Street, 15452, Athens, Greece
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Orthopaedic Department, NIMTS Hospital, Athens, Greece

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Mar 01;88(3):634-638. doi: 10.2106/JBJS.E.00121
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The low-molecular-weight heparins are a group of agents widely used in the prevention of deep-vein thrombosis and pulmonary embolism in orthopaedic patients, especially those undergoing total joint replacement of the lower extremity. They have been in clinical use for almost twenty years and have proved to be at least as effective as other means of thrombosis prevention1. The American College of Chest Physicians has recommended them for routine use in total hip replacement for the past ten years, as an alternative to warfarin and adjusted-dose unfractionated heparin2,3. Their main advantages are that they can be used without laboratory monitoring and they have a favorable therapeutic index (less risk of bleeding compared with unfractionated heparin for a given antithrombotic effect)4. Bleeding and thrombocytopenia are, however, documented complications of the use of low-molecular-weight heparin5-9, but, to our knowledge, cerebral hemorrhages secondary to thrombocytopenia have not been reported in association with orthopaedic procedures. We report the cases of two patients who had thrombocytopenia and cerebral complications after routine treatment with low-molecular-weight heparin for thromboembolic prevention following total hip replacement. Our patients or their families were informed and consented that data concerning their cases would be submitted for publication.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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