title: Timing of heparin prophylaxis and bleeding complications in hysterectomy a nationwide prospective cohort study of 9,949 Danish women.
abstract: OBJECTIVE
  To examine bleeding complications and thromboembolic events in relation to timing of heparin prophylaxis after hysterectomy.
  
  
  METHODS
  Nationwide prospective cohort study with 30 days post-operative follow-up within the Danish Hysterectomy Database (DHD).
  
  
  METHODS
  All gynecological departments in Denmark (n=31).
  
  
  METHODS
  9,949 women who had an elective hysterectomy for benign indication between October 2003 and May 2006 and were reported to DHD (national response rate: 88-99% throughout 2004-2005).
  
  
  METHODS
  Odds ratios (OR) of peri-operative bleeding complications (> or =1,000 ml bleeding during surgery or post-operative wound/vaginal-vault/intraabdominal bleeding or hematoma) and number of events of venous thromboembolism. Logistic regression analysis adjusting for: age, body mass index, alcohol, smoking, meno-/metrorrhagia, uterine weight, department volume, surgeon's experience, route and type of hysterectomy and additional surgery, and stratification on assistant's experience, peri-operative pain prophylaxis with NSAID and daily use of Acetyl Salicylic Acid (ASA)/NSAID.
  
  
  RESULTS
  9,051 women (92%) received thromboprophylaxis with heparin, initiated pre-operatively in 48% and post-operatively in 52%. At least one bleeding complication was noted in 881 women (10%). Post-operative heparin administration was associated with a reduced risk of bleeding complications; OR=0.85 (95% confidence interval 0.73-0.99) compared to pre-operative administration. Excluding cases with potential impaired hemostasis at baseline, the OR was 0.78 (0.64-0.94). There was no fatal embolism. Three of seven pulmonary embolisms and one of three symptomatic deep venous thromboses occurred with the post-operative heparin administration.
  
  
  CONCLUSIONS
  Post-operative rather than pre-operative administration of heparin prophylaxis may reduce the risk of bleeding complications after hysterectomy without apparent risk of increased thromboembolic events.
authors.affiliation: Research Centre for Prevention and Health, 84/85, Glostrup University Hospital, Glostrup, Denmark. thim@dadlnet.dk
authors.forename: Charlotte T
authors.initials: CT
authors.lastname: Hansen
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Charlotte
authors.initials: C
authors.lastname: Møller
authors.forename: Lina
authors.initials: L
authors.lastname: Mørch
authors.forename: Jan
authors.initials: J
authors.lastname: Utzon
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin