Thromboembolic Surveillance Using 125 I Labelled Fibrinogen of 1000 Patients who Underwent Traumatologic and Orthopedic Surgery

From 1975 to 1977, 1006 tests using 125 I fibrinogen have been performed on orthopedic and traumatologic patients who were undergoing a thromboembolic treatment either by means of the association of dipyramidole and aspirin administered orally (24%) or by subcutaneous heparin (76%). The 125 I fibrinogen was injected preoperatively or immediately postoperatively. A daily radioactive counting was performed on the inferior members for approximately 6 to 8 days. 102 venous phlebography controls demonstrated an accuracy of 80% for the 125 I fibrinogen test. Of 1006 patients, 15.2% of the fibrinogen tests were positive, 59.7% of which were positive between the first and fifth postoperative day (p<0.02). The isotopic signs of venous thrombosis occurred in 21% of the hip surgery patients, 14.5% of the lumbar spine surgeries, 13% of the knee surgeries, and 11.5% of the patients who underwent surgery for other traumatic lesions. In these 1006 patients, 9 pulmonary emboli occurred of which 2 were fatal. The 125 I fibrinogen test can only be applied to evolutive thrombosis and does not permit one to differentiate between hematomas and thrombosis, nor to detect pelvic thrombosis. However, this test still remains a simple, faithful, and nontraumatic diagnostic tool in the early detection of thrombosis of the inferior members in patients undergoing traumatologic and orthopedic surgery. Moreover, the labelled fibrinogen test is useful in the determination of the efficacy of antithrombotic preventive medication. Our study has manifested the superiority of subcutaneous heparin (18% positive test) over the association of dipyramidole-aspirin (38.6% positive test) in the prevention of thromboembolic accidents in hip patients (p<0.001).