[Thromboembolic prophylaxis after major abdominal surgery]

Abstract

Purpose: To investigate the efficacy of prophylaxis modalities after major abdominal surgery.

Patients and methods: Patients who underwent major abdominal surgery between October 1998 and October 1999 were randomly divided into 3 groups. The patients in Group 1 received compression stockings, in Group 2 0.3 ml low-molecular weight heparin (nadroparine calcium 0.3 ml, 2850 IU AXa LMWH) subcutaneously and in Group 3 compression stockings and 0.3 ml LMWH. All symptomless patients evaluated with low extremity deep venous Doppler ultrasonography (DUSG), and patients who had pulmonary embolus (PE) suspicion evaluated with pulmonary scintigraphy.

Results: There were 91 patients in Group 1, 91 patients in Group 2 and 92 patients in Group 3. The mean age was 57.25 +/- 13.12, 54.53 +/- 13.54, and 53.65 +/- 13.28 respectively. Male/female ratio was 51/38, 56/35 and 62/30, in Group 1, 2 and 3 respectively. Twenty-seven patients in Group 1, 26 patients in Group 2 and 37 patients in Group 3 had risk factors. DUSG showed deep venous thrombosis (DVT) on the 7th postoperative day in 10 patients in Group 1, in 8 patients in Group 2 and in 3 patients in Group 3. Pulmonary scintigraphy showed PE suspicion in 6 patients in Group 1, 1 patient in Group 2 and 1 patients in Group 3. Wound hematoma and hemorrhage from abdominal drains were developed in 1/0, 8/2 and 3/1 patients in Groups 1, 2 and 3 respectively. Four patients in Group 1 and 2 patients in Group 2 died during the treatment (2.2%). Satistical analysis showed significant differences in PE and wound hematoma between Groups 1 and 2, in DVT and PE between Groups 1 and 3, in risk factors between Groups 2 and 3 (p < 0.05). The differences in DVT and PE and hematoma between group 2 and 3 were not significant.

Conclusion: All treatment modalities could not prevent all thromboembolic complications. In our study combined treatment was the most effective one.