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. 2022 Jun;29(6):776-783.
doi: 10.1016/j.jmig.2022.02.009. Epub 2022 Feb 26.

Effects of Pharmacologic Venous Thromboembolism Prophylaxis in Benign Hysterectomy

Jennifer Travieso  1 , Neil Kamdar  2 , Daniel M Morgan  3 , Sawsan As-Sanie  3 , Sara R Till  3
Affiliations

Effects of Pharmacologic Venous Thromboembolism Prophylaxis in Benign Hysterectomy

Jennifer Travieso et al. J Minim Invasive Gynecol. 2022 Jun.

Abstract

Study objective: To evaluate whether the addition of pharmacologic prophylaxis to mechanical prophylaxis for venous thromboembolism (VTE) is associated with changes in perioperative outcomes in hysterectomy for benign indications.

Design: Retrospective cohort study.

Setting: Michigan Surgical Quality Collaborative database.

Patients: Patients who underwent hysterectomy between July 2012 and June 2015 when VTE prophylaxis data were collected.

Interventions: Patients who received mechanical prophylaxis alone were compared with those receiving dual prophylaxis (mechanical and pharmacologic). Minimally invasive surgeries (MIS) included laparoscopic, vaginal, robotic-assisted, and laparoscopic-assisted vaginal hysterectomies and were analyzed separately from abdominal (ABD) hysterectomy.

Measurements and main results: Propensity score matching was used to minimize confounding because of the differences in demographic and perioperative characteristics. The primary outcome was estimated blood loss (EBL). The secondary outcomes were operative time, postoperative blood transfusion, VTE, surgical site infection, reoperation, readmission, and death. There were 1803 matched pairs in the MIS analysis. In the ABD hysterectomy analysis, 2:1 matching was used with a total of 1168 patients receiving mechanical prophylaxis alone matched to 616 patients receiving dual prophylaxis. EBL was higher by 54.5 mL (95% confidence interval [CI], 16.9-92.1) in those receiving dual prophylaxis in the ABD hysterectomy analysis but did not differ between groups in the MIS analysis. Operative time was significantly longer with dual prophylaxis in both MIS (18.3 minutes; 95% CI, 13.8-22.8) and ABD (15.3 minutes; 95% CI, 9.0-21.6) surgical approaches. There was no difference in other secondary outcomes.

Conclusion: The addition of pharmacologic prophylaxis to mechanical prophylaxis in benign hysterectomy was associated with longer operative time, regardless of surgical approach and increased EBL in ABD hysterectomy. Given very low rates of VTE, no difference in other perioperative outcomes, and possible harm, it seems reasonable to encourage individualized rather than routine use of pharmacologic prophylaxis in patients undergoing benign hysterectomy receiving mechanical prophylaxis.

Keywords: Anticoagulation; Perioperative care, Laparoscopic surgery.

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Conflict of interest statement

Declarations of interest: none

Figures

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Figure 1
Flowchart of study population selection
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References

    1. Walsh JJ, Bonnar J, Wright FW. A study of pulmonary embolism and deep leg vein thrombosis after major gynaecological surgery using labelled fibrinogen-phlebography and lung scanning. J Obstet Gynaecol Br Commonw. 1974;81(4):311–316. - PubMed
    1. Jorgensen EM, Li A, Modest AM, Leung K, Moore Simas TA, Hur HC. Incidence of Venous Thromboembolism After Different Modes of Gynecologic Surgery. Obstet Gynecol. 2018. Nov;132(5):1275–1284. - PubMed
    1. Swenson CW, Berger MB, Kamdar NS, Campbell DA Jr, Morgan DM. Risk factors for venous thromboembolism after hysterectomy. Obstet Gynecol. 2015. May;125(5):1139–44. - PMC - PubMed
    1. Brummer TH, Heikkinen A, Jalkanen J, Fraser J, Mäkinen J, Tomás E, et al. Pharmaceutical thrombosis prophylaxis, bleeding complications and thromboembolism in a national cohort of hysterectomy for benign disease. Hum Reprod. 2012;27:1628–36. - PubMed
    1. Kahr HS, Thorlacius-Ussing O, Christiansen OB, Skals RK, Torp-Pedersen C, Knudsen A. Venous Thromboembolic Complications to Hysterectomy for Benign Disease: A Nationwide Cohort Study. J Minim Invasive Gynecol. 2018. May – Jun;25(4):715–723.e2. - PubMed

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