Document Detail


Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review.
MedLine Citation:
PMID:  17449089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Advanced age, pelvic surgery, and the presence of malignancy place gynecologic oncology patients at high risk for venous thromboembolism (VTE). This study was designed to systematically analyze the world's literature on VTE in these patients and determine the optimal prophylaxis regimen. METHODS: Computerized searches of Pubmed, Ovid, DARE, ACP Journal Club, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials Registry 1966-2005 were performed, as well as EMBASE 1980-2005. Major conferences and target references were hand-searched. Inclusion criteria were randomized controlled trials (RCTs) evaluating VTE prophylaxis with heparin, low-molecular-weight heparin (LMWH), and sequential compression devices (SCD). The search yielded 278 articles; 11 met inclusion criteria. Data were abstracted by one author and analyzed with the Mantel-Haenszel method. RESULTS: The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin (RR=0.58, 95% CI 0.35-0.95). There were no significant differences in EBL or transfusions between the two groups. In the 320 patients in the heparin vs. LMWH studies, there was no significant difference in DVT (RR 0.91, 95% CI 0.38-2.17), although power analysis demonstrated insufficient numbers to show a difference. No patient in either group required re-exploration for bleeding. CONCLUSIONS: All gynecologic cancer patients should receive VTE prophylaxis. Although heparin, LMWH, and SCD have been shown to be safe and effective, due to the paucity of data in the gynecologic oncology literature, no one prevention modality can be considered superior at this time. Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.
Authors:
M Heather Einstein; Elizabeth A Pritts; Ellen M Hartenbach
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-04-20
Journal Detail:
Title:  Gynecologic oncology     Volume:  105     ISSN:  0090-8258     ISO Abbreviation:  Gynecol. Oncol.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-21     Completed Date:  2007-06-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0365304     Medline TA:  Gynecol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  813-9     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI 53792, USA. mh.einstein@hosp.wisc.edu
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Female
Genital Neoplasms, Female / complications,  surgery*
Gynecologic Surgical Procedures / methods
Heparin / therapeutic use
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Randomized Controlled Trials as Topic
Thromboembolism / etiology,  prevention & control*
Venous Thrombosis / prevention & control*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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