LMWH IN GYNECOLOGIC SURGERY

A practical approach to using low-molecular-weight heparin in gynecologic surgery patients

By Louis A. Dainty, MD, G. Larry Maxwell, MD, and Daniel L. Clarke-Pearson, MD

Thromboembolic complications are common after gynecologic cancer surgery. All too often, however, DVT is discovered on autopsy. The authors offer a practical evidence-based perspective on prophylaxis with external pneumatic compression and LMWH.

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major complications of surgery for gynecologic cancer that result in significant morbidity and mortality. Approximately 260,000 cases of clinically diagnosed DVT occur every year, resulting in 100,000 recognized deaths directly attributed to PE.^1,2 The incidence of DVT in gynecologic surgery varies widely, depending on each patient's individual risk factors.

Studies using the most sensitive detection methods suggest that about 14% of patients undergoing gynecologic surgery for benign indications develop thromboembolism.³ DVT has been observed in 38% of patients after surgery for gynecologic cancer.⁴ PE accounts for 3% of all deaths following gynecologic surgery and is a leading cause of postoperative death in the highest-risk patients with uterine, ovarian, or cervical carcinoma.^5,6 Thirty percent of patients who have a perioperative thromboembolic event are also at risk for chronic postthrombotic syndrome (characterized by venous ulceration, debilitating pain, and intractable edema).⁷ As many as 90% of patients with venous thrombosis are found to have milder forms of disability when follow-up is extended for 2 to 5 years. The economic costs of thromboembolism are expected to rise as the prevalence of this preventable cardiovascular disease increases in the aging population.^8,9