Venous thromboembolism prevention: GYN surgery

Venous thromboembolism prevention in gynecologic cancer surgery: A systematic review

M. Heather Einsteina, Elizabeth A. Prittsb and Ellen M. Hartenbacha

aDepartment of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI, USA bWisconsin Fertility Institute, Madison, WI, USA

Abstract

Objectives.

Advanced age, pelvic surgery, and the presence of malignancy place gynecologic oncology patients at high risk for venous thromboembolism (VTE).

This study was designed to systematically analyze the world's literature on VTE in these patients and determine the optimal prophylaxis regimen.

Methods.

Computerized searches of Pubmed, Ovid, DARE, ACP Journal Club, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials Registry 1966–2005 were performed, as well as EMBASE 1980–2005. Major conferences and target references were hand-searched.

Inclusion criteria were randomized controlled trials (RCTs) evaluating VTE prophylaxis with heparin, low-molecular-weight heparin (LMWH), and sequential compression devices (SCD). The search yielded 278 articles; 11 met inclusion criteria.

Data were abstracted by one author and analyzed with the Mantel–Haenszel method.

Results.

The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin (RR = 0.58, 95% CI 0.35–0.95). There were no significant differences in EBL or transfusions between the two groups.

In the 320 patients in the heparin vs. LMWH studies, there was no significant difference in DVT (RR 0.91, 95% CI 0.38–2.17), although power analysis demonstrated insufficient numbers to show a difference. No patient in either group required re-exploration for bleeding.

Conclusions.

All gynecologic cancer patients should receive VTE prophylaxis. Although heparin, LMWH, and SCD have been shown to be safe and effective, due to the paucity of data in the gynecologic oncology literature, no one prevention modality can be considered superior at this time.

Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.





Corresponding author. Division of Gynecologic Oncology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, H4/636, Madison, WI 53792, USA. Fax: +1 608 265 6572.

Gynecologic Oncology, April 2007

doi:10.1016/j.ygyno.2007.03.004

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