Ailawadi M, Del Priore G.
A comparison of thromboembolic prophylaxis in gynecologic oncology patients.
Int J Gynecol Cancer 2001 Sep-Oct;11(5):354-8

Division of Gynecologic Oncology, New York University School of Medicine, New
York, New York 10016, USA.

The objective of this study was to compare two methods of thromboembolic
prophylaxis: sequential compression devices alone (SCDs) vs. SCDs with
subcutaneous low-dose unfractionated heparin (UH). A retrospective cohort study
was conducted of 168 patients who had undergone surgery for suspected
gynecological malignancies. These patients were examined for associated risk
factors, method of prophylaxis, and incidence of clinically significant
thromboembolic events. Of these patients, 94 (56%) received perioperative and
postoperative sequential compression devices alone, while 74 (44%) received both
SCDs and subcutaneous low-dose UH. The postoperative course of these patients,
while in the hospital and after discharge, was followed for clinically evident
thromboembolic complications. Univariate and multivariate analyses were
performed. The two groups were comparable in terms of most risk factors,
including age, stage, height, weight, body surface area, estimated blood loss,
total anesthesia time, and nodal disease. Six of 94 patients (6.4%) in the SCDs
group suffered from venous thromboembolism, while four of 74 patients (5.4%) who
received both SCDs and low-dose UH had a thromboembolic event (chi2 P = 0.79).
There was no difference in postoperative changes in platelet counts between the
two groups. Heparin added additional cost, 105 extra minutes of nursing time per
patient per admission, and additional pain for the patient. In conclusion, the
addition of subcutaneous low-dose unfractionated heparin to SCDs for prophylaxis
against deep venous thrombosis in women undergoing surgery for gynecologic
malignancies does not improve the outcome. Adding heparin was more expensive,
time consuming, and painful. Heparin should not be used with SCDs unless an
additional benefit can be demonstrated in a randomized controlled trial.