Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: A randomized trial

Objective: To compare the efficacy and treatment-related complications of l ow molecular weight heparin and external pneumatic compression in the preve ntion of venous thromboembolism of postoperative gynecologic oncology patie nts. Methods: A total of 211 patients over age 40 years, undergoing a major oper ative procedure for gynecologic malignancy, were randomized to receive peri operative thromboembolism prophylaxis with either low molecular weight hepa rin (n=105) or external pneumatic compression (n=106). Demographic data and clinical outcome were recorded for each patient. All patients underwent bi lateral 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 de ep vein thrombosis or pulmonary embolism after hospital discharge. Results: Venous thrombosis was diagnosed in two patients receiving low mole cular weight heparin and in one patient receiving external pneumatic compre ssion. The frequency of bleeding complications, measured by the number of r equired 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 thromboembolis m. The use of low molecular weight heparin is not associated with an increa sed risk of bleeding complications when compared with external pneumatic co mpression. We believe that both modalities are reasonable choices for proph ylaxis in this high-risk group of patients.(Obstet Gynecol 2001;98: 989-95. (C) 2001 by the American College of Obstetricians and Gynecologists.).