Abstract | BACKGROUND: Abdominal surgery carries a significant risk of venous thrombosis, a risk further increased in patients with cancer. METHODS: Embase and Pubmed searches between 1980 and 2003, using the key words ' heparin,' 'surgery,' 'abdominal or rectal or colorectal or rectum or colon' and 'clinical trial', were conducted to identify studies of thromboprophylaxis in patients having abdominal surgery. RESULTS: A total of 16 comparative studies were identified. These show that low molecular weight heparin ( LMWH) is as effective as unfractionated heparin (UFH) in reducing venous thromboembolism after abdominal surgery and, at appropriate doses, can reduce bleeding complications. In very high-risk patients, a higher dose of LMWH may offer increased efficacy without increasing bleeding risk. Extending the standard 7-10-day period of prophylaxis may benefit certain high-risk groups; recent data show a significant benefit of 4-week enoxaparin thromboprophylaxis compared with a standard regimen, at no cost to safety. CONCLUSION: Patients undergoing abdominal surgery should be stratified according to thromboembolism risk and managed accordingly. LMWH is a recommended alternative to UFH in moderate- or high-risk patients. In patients with cancer, high doses of LMWH may offer increased efficacy without increasing the bleeding risk and an extended 4-week period of prophylaxis appears beneficial.
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Authors | D Bergqvist |
Journal | The British journal of surgery
(Br J Surg)
Vol. 91
Issue 8
Pg. 965-74
(Aug 2004)
ISSN: 0007-1323 [Print] England |
PMID | 15286956
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Copyright | Copyright 2004 British Journal of Surgery Society Ltd. |
Chemical References |
- Anticoagulants
- Heparin, Low-Molecular-Weight
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Topics |
- Abdomen
(surgery)
- Anticoagulants
(therapeutic use)
- Colon
(surgery)
- Dose-Response Relationship, Drug
- Double-Blind Method
- Heparin, Low-Molecular-Weight
(therapeutic use)
- Humans
- Meta-Analysis as Topic
- Postoperative Complications
(prevention & control)
- Randomized Controlled Trials as Topic
- Rectum
(surgery)
- Risk Factors
- Thromboembolism
(prevention & control)
- Treatment Outcome
- Venous Thrombosis
(prevention & control)
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