Low-molecular-weight heparin for the prevention of postoperative venous thromboembolism after abdominal surgery: a review.
OBJECTIVE
To analyze the effect of low-molecular-weight heparin in abdominal surgery, which carries a significant risk of thrombosis, a risk further increased by cancer.


RESULTS
Searches in EMBASE and PubMed between 1980 and 2004 were conducted to identify studies of thromboprophylaxis in abdominal surgery patients. Sixteen comparative studies were identified. They showed that low-molecular-weight heparin is as effective as unfractionated heparin in reducing venous thromboembolism and, at appropriate doses, can reduce bleeding complications. In very-high-risk cancer patients, a higher dose of low-molecular-weight heparin may offer increased efficacy without increasing the risk of bleeding. Extending the standard 7-10-day low-molecular-weight heparin prophylaxis period may benefit certain high-risk patient groups.


CONCLUSIONS
Patients undergoing abdominal surgery should be stratified according to thromboembolism risk and given prophylaxis accordingly. Low-molecular-weight heparin is a recommended alternative to unfractionated heparin in moderate- or high-risk patients. In patients with cancer, high doses of low-molecular-weight heparin may offer increased efficacy without increased bleeding, and an extended 4-week period of prophylaxis could be beneficial.
Bergqvist
David
D
Department of Surgery, University Hospital, Uppsala, Sweden. david.bergqvist@surgsci.uu.se
D000925:Anticoagulants / Q000627:therapeutic use*; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D004066:Digestive System Diseases / Q000453:epidemiology / Q000601:surgery; D004067:Digestive System Neoplasms / Q000453:epidemiology / Q000601:surgery; D013505:Digestive System Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D017762:Nadroparin / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D018570:Risk Assessment; D013923:Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D017762:Nadroparin