Effects of enoxaparin, standard heparin, and streptokinase on the patency of anastomoses in severely crushed arteries.

The effects of topical irrigation with three antithrombotic agents on the patency of anastomosed arteries following crush injury were examined. Following an impact crush injury with a 25 kg crush load, the femoral arteries of rats were divided and then anastomosed. During anastomoses, the vessel lumina were topically irrigated with saline, streptokinase, standard heparin, or enoxaparin (a low molecular weight heparin). The results were evaluated by patency test and histology up to day 56. The thrombosis rate at days 1 and 7 was statistically lower (P < 0.05) in the standard heparin and the enoxaparin groups than in the other two groups. The difference between the standard heparin and the enoxaparin groups was not statistically significant. Histology at day 1 showed that thrombus in the occluded vessels adhered to the exposed adventitia in the crushed area or the adventitia was covered by fibrin, red blood cells, and platelet mesh in the patent vessels. The results showed that 1) topical irrigation with standard heparin or enoxaparin solution significantly reduced the thrombosis rate at the anastomosis site of the crushed arteries; and 2) enoxaparin was as effective an antithrombotic agent as standard heparin when topically applied during microvascular anastomoses.

Duke Scholars

Author James Randolph Urbaniak Orthopaedic Surgery