Different combination strategies for prophylaxis of venous thromboembolism in patients: A prospective multicenter randomized controlled study

Abstract

The aim was to evaluate the efficacy and safety of different combination strategies for prophylaxis of venous thromboembolism (VTE) after gynecologic surgery in patients at different levels of risk. This was a prospective multicenter randomized controlled study, in which 625 women who would undergo pelvic surgery for gynecologic diseases were stratified into three risk groups and then randomized into four groups to receive graduated compression stockings (GCS) alone (group A), GCS + low molecular weight heparin (LMWH) (group B), GCS + intermittent pneumatic compression (IPC) (group C), and GCS + IPC + LMWH (group C), respectively. The overall incidence of DVT was 5.1%. Group A had the highest incidence of DVT (8.8%), followed by group C (5.2%), group B (3.8%), and group D (2.6%). There was a significant difference in the incidence of DVT between groups A and D. The incidence of DVT was significantly lower in LMWH-treated patients (group B + group D) than in non-LMWH-treated patients (group A + group C). In conclusion, combination prophylaxis, especially LMWH-containing strategies, is better than monoprophylaxis in reducing VTE after gynecologic surgery. Risk-stratified prophylactic strategies should be implemented in patients undergoing gynecologic surgery, with LMWH-containing strategies being recommended for high-risk and very-high-risk patients.

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

“…In an Asian study, an RCT of Chinese patients, the patients were randomized into four groups to receive graduated compression stockings (GCSs) alone (group A), GCS + LMWH (group B), GCS + IPCD (group C), and GCS + IPCD + LMWH (group D) [ 42 ]. The overall incidence of DVT was 5.1% [ 42 ]. Group A had the highest incidence of DVT (8.8%), followed by group C (5.2%), group B (3.8%), and group D (2.6%) [ 42 ].…”

Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients

“…Importantly, a further 29 articles were excluded as they included patients at moderate or high-risk of HAT. 15 – 43 After full-text exclusions took place, a narrative synthesis was performed on a single article. 44 …”

“…There were 20 articles identified in the article screening process, which were subsequently excluded, consisting of moderate and high-risk surgical patients containing a single study arm assessing the use of GCS alone in the reduction of HAT. 19 , 21 – 23 , 25 – 30 , 32 – 35 , 37 – 40 , 42 , 43 All of the study arms consisted of patients using GCS without the addition of LMWH. The rate of HAT was as high as 59.2% in patients undergoing knee surgery.…”

Prevention of subclinical deep vein thrombosis in abdominal surgeries

“…Combination of these strategies have been recommended by some for high risk DVT patients. 22 Warfarin sodium is an effective option for treating DVT, however dose adjustments based on INR have to be done. 23,24 Present study has similar results, as suggested by literature.…”