The profylaxis of venous thromboembolism in gynecology

Česká verzia

Authors: P. Ďulíček ¹; J. Malý ¹; R. Malý ²
Authors place of work: Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ¹; I. interní klinika Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jan Vojáček, CSc. ²
Published in the journal: Vnitř Lék 2009; 55(3): 216-218
Category: 15th Parizek's Days

Summary

The venous thromboembolism is a serious disease, but it is possible to some extend eliminate it by proper thromboprophylaxis. The recommendations in gynecology result from guidelines not only in surgery and the internal medicine, but also from specific gynecologic conditions. The early and frequent mobilization is recommended for minor gynecological surgery and laparoscopic procedures. For major gynecological surgery and laparoscopic procedures in whom additional VTE risk factors are present, low molecular weight heparin is indicated. In major gynecological surgery for malignancy, low molecular heparin is needed in dose at least 4,000 antiXa IU. The prolonged prophylaxis for 28 days is also suitable in this setting.

Key words:
venous thromboembolism – prophylaxis – low molecular heparin – prolonged prophylaxis

Zdroje

1. Dulíček P, Penka M, Binder T et al. Návrh antitrombotické profylaxe a péče o trombofilní stavy v gynekologii a porodnictví. Vnitř Lék 2006; 52 (Suppl 1): 58–62.

2. Dulíček P. Trombofilní stavy. Vnitř Lék 2005; 51: 819–824.

3. Antithrombotic and thrombolytic therapy 8th ED: ACCP guidelines. Prevention of venous thromboembolism. Chest 2008; 133/6: 381S–728S.

4. Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 338S–400S.

5. Abu-Rustum NR, Richard S, Wilton A et al. Transfusion utilization during adnexal or peritoneal cancer surgery: effects on symptomatic venous thromboembolism and survival. Gynecol Oncol 2005; 99: 320–326.

6. Heilmann L, von Tempelhoff GF, Schneider D. Prevention of thrombosis in gynecologic malignancy. Clin Appl Tromb/Hemost 1998; 4: 153–159.

7. Ward B, Pradhan S. Comparison of low molecular weight heparin (fragmin) with sodium heparin for prophylaxis against postoperative thrombosis in women undergoing major gynaecological surgery. Aust N Z J Obstet Gynaecol 1998; 38: 91–92.

8. Baykal C, Al A, Demirtas E at al. Comparison of enoxaparin and standard heparin in gynaecologic oncologic surgery: a randomised prospective double-blind clinical study. Eur J Gynaec Oncol 2001; 22: 127–130.

9. Maxwell GL, Synan I, Dodge R et al. Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Obstet Gynecol 2001; 98: 989–995.

10. Oates-Whitehead RM, D’Angelo A, Mol B. Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynaecological surgery. Cochrane Database Syst Rev 2003; 4: CD003679.

11. Ageno W, Manfredi E, Dentali F et al. The incidence of venous thromboembolism following gynecologic laparoscopy: a multicenter, prospective cohort study. J Thromb Haemost 2007; 5: 503–506.

12. Abu-Rustum NR, Chi DS, Sonoda Y et al. Transperitoneal laparoscopic pelvic and para‑aortic lymph node dissection using the argon-beam coagulator and monopolar instruments: an 8-year study and description of technique. Gynecol Oncol 2003; 89: 504–513.

13. Panici PB, Plotti F, Zullo MA et al. Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol 2006; 103: 859–864.

14. Clarke-Pearson DL, Delong E, Synan IS et al. A controlled trial of two low‑dose heparin regimens for the prevention of postoperative deep vein thrombosis. Obstet Gynecol 1990; 75: 684–689.

15. Clarke-Pearson DL, Synan IS, Dodge R et al. A randomized trial of low‑dose heparin and intermittent pneumatic calf compression for the prevention of deep venous thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol 1993; 168: 1146–1154.

16. Enoxacan Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized-multicentre trial with venographic assessment. Br J Surg 1997; 84: 1099–1103.

17. Fricker JP, Vergnes Y, Schach R et al. Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery. Eur J Clin Invest 1988; 18: 561–567.

18. Heilman L, von Templehoff GF, Kirkpatrick C et al. Comparison of unfractionated versus low molecular weight heparin for deep vein thrombosis prophylaxis during breast and pelvic cancer surgery: efficacy, safety, and follow‑up. Clin Appl Thromb/Hemosts 1998; 4: 268–273.

19. Bergqvist D, Agnelli G, Cohen AT et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002; 346: 975–980.