Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery

Bradley R. Corr, Andrea M. Winter, Mary D. Sammel, Christina S. Chu, Brian F. Gage, Andrea R. Hagemann

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objective To determine the effectiveness and safety of an expanded perioperative venous thromboembolism (VTE) prophylaxis strategy in women undergoing complex gynecologic surgery. Methods We performed a cohort study of 527 patients undergoing major surgery at a single institution over a thirty-month interval during which the gynecologic oncology service implemented an expanded approach to VTE prophylaxis. We compared rates of VTE pre- and post-intervention as well as bleeding and infectious complications. Results Prior to the intervention, there were 23 VTE events in 345 patients (rate of 6.67%): 8 deep vein thromboses (DVTs) and 15 pulmonary emboli (PEs). Post-intervention, there were 5 VTE events in 182 patients (2.7%): 3 DVTs and 2 PEs (RR = 0.4, p = 0.056). Time-to-event analysis showed a significantly higher incidence of VTE events in the pre-intervention time frame compared to the post-intervention period (p = 0.049). There were no significant differences in bleeding or infection complications between groups. Conclusions Implementation of a perioperative VTE prophylaxis protocol was safe, feasible and resulted in a clinically significant reduction in symptomatic VTE. Preoperative single-dose unfractionated heparin for all patients, combined with two weeks of thromboprophylaxis in gynecologic cancer patients, may decrease VTE events without increasing bleeding or infection.

Original languageEnglish
Pages (from-to)501-506
Number of pages6
JournalGynecologic oncology
Volume138
Issue number3
DOIs
StatePublished - Sep 1 2015

Keywords

  • Extended prophylaxis
  • Gynecologic surgery
  • Perioperative outcomes
  • Venous thromboembolism

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