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Evidence summaries

Prolonged Thromboprophylaxis with Low Molecular Weight Heparin for Abdominal or Pelvic Surgery

Prolonged thromboprophylaxis with low-molecular weight heparin (LMWH) appears to reduce the risk of venous thromboembolism compared to thromboprophylaxis during hospital admittance only, without increasing bleeding complications or mortality after major abdominal or pelvic surgery. Level of evidence: "B"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and high loss to follow-up).

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 1 728 subjects to evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 14 days after abdominal or pelvic surgery compared with thromboprophylaxis administered during the in-hospital period only in preventing late onset venous thromboembolism (VTE). Prolonged thromboprophylaxis with LMWH was compared to control or placebo. Five studies included only cancer patients and 2 studies included patients undergoing surgery for both benign and malignant diseases. One study performed minimally invasive (laparoscopic) abdominal surgery, and the remaining studies open surgery.

The incidence of overall venous thromboembolism (VTE), all deep venous thrombosis (DVT), and proximal DVT was reduced in the prolonged thromboprophylaxis group (table T1).The observed reduction in the incidence of symptomatic VTE was not statistically significant.No difference in the incidence of bleeding and in mortality was found.

Prolonged (HASH(0x2fcfe80)14 days) thromboprophylaxis with LMWH compared to only in-hospital thrombopropylaxis

OutcomeRelative effect (95% CI)Risk with controlRisk with prolonged LMWH (95% CI)Participants (studies)
VTE = venous thromboembolism; DVT = deep venous thrombosis; * follow-up 30 days postoperatively; **follow-up 3 months postoperatively
All VTE*OR 0.38 (0.26 to 0.54)132 per 100050 per 1000(34 to 71)1 728(7 studies)
All DVT*OR 0.39 (0.27 to 0.55)129 per 100050 per 1000(35 to 71)1 728(7 studies)
Proximal DVT*OR 0.22 (0.10 to 0.47)39 per 10009 per 1000(4 to 18)1 728(7 studies)
Symptomatic VTE*OR 0.30 (0.08 to 1.11)10 per 10003 per 1000(1 to 11)1 728(7 studies)
Mortality**OR 1.15 (0.72 to 1.84)38 per 100043 per 1000(28 to 68)1 881(7 studies)
Bleeding complications**OR 1.10 (0.67 to 1.81)28 per 100031 per 1000(19 to 51)2 239 (7 studies)

    References

    • Felder S, Rasmussen MS, King R et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 2019;(8):CD004318. [PubMed].

Primary/Secondary Keywords