A comparison of thromboembolic prophylaxis in gynecologic oncology patients

The objective of this study was to compare two methods of thromboembolic pr ophylaxis: sequential compression devices alone (SCDs) vs. SCDs with subcut aneous low-dose unfractionated heparin (UH). A retrospective cohort study w as conducted of 168 patients who had undergone surgery for suspected gyneco logical malignancies. These patients were examined for associated risk fact ors, method of prophylaxis, and incidence of clinically significant thrombo embolic events. Of these patients, 94 (56%) received perioperative and post operative sequential compression devices alone, while 74 (44%) received bot h SCDs and subcutaneous low-dose UH. The postoperative course of these pati ents, while in the hospital and after discharge, was followed for clinicall y evident thromboembolic complications. Univariate and multivariate analyse s were performed. The two groups were comparable in terms of most risk fact ors, including age, stage, height, weight, body surface area, estimated blo od 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 (chi (2) P=0.79). There was no difference in postoperative changes i n platelet counts between the two groups. Heparin added additional cost, 10 5 extra minutes of nursing time per patient per admission, and additional p ain for the patient. In conclusion, the addition of subcutaneous low-dose u nfractionated heparin to SCDs for prophylaxis against deep venous thrombosi s in women undergoing surgery for gynecologic malignancies does not improve the outcome. Adding heparin was more expensive, time consuming, and painfu l. Heparin should not be used with SCDs unless an additional benefit can be demonstrated in a randomized controlled trial.