title: A protocol of dual prophylaxis for venous thromboembolism prevention in gynecologic cancer patients.
abstract: OBJECTIVE
  To evaluate a quality improvement protocol for venous thromboembolism prevention in postoperative gynecologic cancer patients.
  
  
  METHODS
  On January 1, 2006, we initiated a universal protocol of dual prophylaxis with sequential compression devices and three times daily heparin (or daily low molecular weight heparin) until discharge in gynecologic cancer patients having major surgery. Patients with both malignancy and age over 60 years (or history of prior clot) were discharged on 2 weeks of anticoagulant. Before January 2006, all patients were given sequential compression devices starting before the induction of anesthesia, continuing until discharge from the hospital. Records of gynecologic cancer service patients admitted in 2005 and 2006 were reviewed, excluding patients with a history of heparin-induced thrombocytopenia or those admitted on an anticoagulant. Any pulmonary embolism or deep vein thrombosis diagnosed within 6 weeks of surgery was identified. We performed chi2 and Wilcoxon rank sum tests as well as multivariable regression analysis for confounders.
  
  
  RESULTS
  Six of the 311 women meeting inclusion criteria in 2006 (1.9%) and 19 of 294 (6.5%) in 2005 had venous thromboembolism (odds ratio 0.33, 95% confidence interval 0.12-0.88, multivariable analysis adjusting for baseline differences between the groups). Heparin was given to 98.1% of patients in the hospital in 2006, and 91.1% of those meeting high-risk criteria were discharged on an anticoagulant. No differences in major bleeding complications were seen between years.
  
  
  CONCLUSIONS
  A protocol of dual prophylaxis with prolonged prophylaxis in high-risk patients was successfully implemented and was associated with a significant reduction in the rate of venous thromboembolism without increasing bleeding complications.
  
  
  METHODS
  II.
authors.affiliation: Division of Gynecologic Oncology, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA. heather.einstein@gmail.com
authors.forename: M Heather
authors.initials: MH
authors.lastname: Einstein
authors.forename: David M
authors.initials: DM
authors.lastname: Kushner
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Connor
authors.forename: Alex A
authors.initials: AA
authors.lastname: Bohl
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Best
authors.forename: Michael D
authors.initials: MD
authors.lastname: Evans
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Chappell
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Hartenbach
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight