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Thromb Haemost 2008; 99(06): 1104-1111
DOI: 10.1160/TH07-12-0759
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Efficacy of extended thrombo-prophylaxis in major abdominal surgery: What does the evidence show?

A meta-analysis
Federico Jorge Bottaro
1   Departments of Internal Medicine and
3   Thrombosis Research Unit, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
,
Maria Cristina Elizondo
1   Departments of Internal Medicine and
,
Carlos Doti
3   Thrombosis Research Unit, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
,
Julio Enrique Bruetman
1   Departments of Internal Medicine and
,
Pablo Diego Perez Moreno
1   Departments of Internal Medicine and
,
Eduardo Oscar Bullorsky
,
Jose Manuel Ceresetto
3   Thrombosis Research Unit, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

Received 29 December 2007

Accepted after major revision 10 April 2008

Publication Date:
28 November 2017 (online)

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Summary

Venous thromboembolism (VTE) is a frequent complication following major abdominal surgery. The use of low-molecular-weight heparins (LMWH) to prevent thrombotic events in these patients is a common and well documented practice. However, there is some controversy surrounding the duration of the prophylaxis, as it has been suggested that the risk persists for several weeks after surgery.The objective of this meta-analysis is to systematically review the clinical studies that compared safety and efficacy of extended use of LMWH (for three to four weeks after surgery) versus conventional in-hospital prophylaxis. An electronic data base search was performed. Only randomized, controlled studies were eligible. Data on the incidence of deep vein thrombosis (DVT), VTE and bleeding were extracted. Only three studies fulfilled the inclusion criteria. The indication for surgery was neoplastic disease in 70.6% (780/1104) of patients. The administration of extended LMWH prophylaxis significantly reduced the incidence of VTE, 5.93% (23/388) versus 13.6% (55/405), RR 0.44 (CI 95% 0.28 – 0.7); DVT 5.93% (23/388) versus 12.9% (52/402), RR 0.46 (CI 95% 0,29 – 0,74); proximal DVT 1% (4/388) versus 4.72% (19/402), RR 0.24 (CI 95% 0.09 – 0,67). We found no significant difference in major or minor bleeding between the two groups: 3.85% (21/545) in the extended thrombo-prophylaxis (ETP) group versus 3.48% (19/559) in the conventional prophylaxis group; RR 1.12 (CI 95% 0.61 – 2.06). There was no heterogeneity between the studies. We conclude that ETP with LMWH should be considered as a safe and useful strategy to prevent VTE in high-risk major abdominal surgery.

Keywords

Cancer - major abdominal surgery - venous thromboembolism - low-molecular-weight heparins - extended thrombo-prophylaxis
 

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