Maxwell GL, Synan I, Dodge R, Carroll B, Clarke-Pearson DL.
Pneumatic compression versus low molecular weight heparin in gynecologic oncology
surgery: a randomized trial.
Obstet Gynecol 2001 Dec;98(6):989-95

Division of Gynecologic Oncology, The Duke Comprehensive Cancer Center,
Biostatistics Section, Durham, North Carolina 27710, USA.

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.