July 2004 · Vol. 16, No. 7Thromboembolic disease: The case for routine prophylaxis
Preventive strategies can reduce fatal pulmonary embolism as much as 75% in gynecologic surgery patients. This article explains the evidence on how to assess risk and choose mechanical and drug therapies for these women, including gravidas.
RODNEY
G.
MEEKS,
MD;
SHANNON
C.
CARROLL,
DODr. Meeks is professor and Winfred L. Wiser Chair of Gynecologic Surgery, and Dr. Carroll is assistant professor, department of obstetrics and gynecology, University of Mississippi,
Jackson, Miss.
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KEY POINTS
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Prophylaxis must start before surgery for maximal benefit, since at least 50% of postoperative thromboembolic disease begins intraoperatively.
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A consensus conference found that prophylaxis reduced fatal pulmonary emboli by 75% in 7,000 gynecologic surgery patients.
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Low-dose unfractionated heparin and low molecular weight heparin appear similarly effective in reducing thromboembolic disease in perioperative patients, but it is unclear which form has fewer bleeding complications.
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The case is strong for routine prophylaxis against venous thrombosis and pulmonary embolism. The primary reasons: efficacy, ease of use, and safety.
This article reviews the evidence on routine prophylaxis, pros and cons of mechanical and drug therapies (including a comparison of 2 heparins), patient risk factors, and cost-effectiveness. A table (page 32) lists patient characteristics for low, moderate, high, and very high levels of risk, with corresponding appropriate preventive measures.
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