Readmission after hysterectomy and prophylactic low molecular weight heparin: retrospective case-control study.
OBJECTIVE
To determine whether use of tinzaparin, a low molecular weight heparin introduced for prophylactic management of deep vein thrombosis, increases the risk of serious postoperative bleeding leading to a higher than expected 28 day readmission rate after discharge for hysterectomy.


METHODS
Retrospective case-control study using computerised hospital inpatient data and review of case notes.


METHODS
District general hospital.


METHODS
2108 patients undergoing hysterectomy between August 1997 and March 2003


METHODS
Readmission and reoperation associated with bleeding.


RESULTS
54 cases of serious postoperative bleeding were identified, 46 of which were readmissions. These 54 cases were compared with 179 controls. Regression analysis indicated a positive relation between prophylaxis with tinzaparin and serious postoperative bleeding. There was a significant twofold increase in odds (odds ratio 2.02, 95% confidence interval 1.02 to 4.05) after adjustment for type of operation, age, and type of pain relief.


CONCLUSIONS
In the prophylactic treatment of thromboembolic disease after hysterectomy, compared with calci-heparin, tinzaperin is associated with a twofold increase in risk of serious postoperative bleeding.
Stockport NHS Trust, Stepping Hill Hospital, Stockport SK2 7JE. Gary.cook@stockport.nhs.uk
Gary
G
Cook
John
J
Depares
Maneesh
M
Singh
Patrick
P
McElduff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*; D000078222:Tinzaparin
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin