Elsevier

Obstetrics & Gynecology

Volume 98, Issue 6, December 2001, Pages 989-995
Obstetrics & Gynecology

Original research
Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial

https://doi.org/10.1016/S0029-7844(01)01601-5Get rights and content

Abstract

OBJECTIVE:

To compare the efficacy and treatment-related complications of low molecular weight heparin and external pneumatic compression in the prevention of venous thromboembolism of postoperative gynecologic oncology patients.

METHODS:

A total of 211 patients over age 40 years, undergoing a major operative procedure for gynecologic malignancy, were randomized to receive perioperative thromboembolism prophylaxis with either low molecular weight heparin (n = 105) or external pneumatic compression (n = 106). Demographic data and clinical outcome were recorded for each patient. All patients underwent bilateral Doppler ultrasound of the lower extremities on postoperative days 3–5 to evaluate for the presence of occult deep vein thrombosis. A follow-up interview 30 days after surgery sought to detect patients who developed deep vein thrombosis or pulmonary embolism after hospital discharge.

RESULTS:

Venous thrombosis was diagnosed in two patients receiving low molecular weight heparin and in one patient receiving external pneumatic compression. The frequency of bleeding complications, measured by the number of required perioperative transfusions, and estimated intraoperative blood loss was similar between the two groups.

CONCLUSION:

Low molecular weight heparin and external pneumatic compression are similarly effective in the postoperative prophylaxis of thromboembolism. The use of low molecular weight heparin is not associated with an increased risk of bleeding complications when compared with external pneumatic compression. We believe that both modalities are reasonable choices for prophylaxis in this high-risk group of patients.

Section snippets

Materials and methods

All patients, over 40 years of age, admitted to the Gynecologic Oncology Service at Duke University Medical Center, undergoing major abdominal or pelvic surgery for known or suspected gynecologic malignancy, were offered participation in this study, which had been approved by the Institutional Review Board. Patients were ineligible for the following reasons: deep vein thrombosis or pulmonary embolism within the previous 6 months; contraindications to heparin therapy; conduction anesthesia;

Results

A total of 228 of 231 patients were entered into the study. Three patients declined participation before randomization. Twelve patients were excluded after randomization because their surgeries were cancelled. Four patients withdrew from the study before surgery. One additional patient was diagnosed with a symptomatic deep vein thrombosis preoperatively prompting exclusion. Using an intent-to-treat approach, 211 patients were randomized to receive either external pneumatic compression (106) or

Discussion

We have previously evaluated several methods of thromboembolism prophylaxis in an effort to identify the most effective modality associated with the least side effects in the prevention of postoperative thromboembolism among gynecologic oncology patients undergoing major surgery. A regimen of unfractionated heparin (5000 units SQ) given 2 hours preoperatively and Q 12 hours postoperatively was found to be ineffective in lowering the incidence of deep vein thrombosis in these high-risk patients.

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Supported in part by unrestricted educational grants from the Pharmacia Corporation and Venodyne, and the ACOG/Ethicon Research Award for Innovations in Gynecologic Surgery. These grants were used for research nurse salary and the expenses of sonographic studies.

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