title: Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial.
abstract: BACKGROUND
  Deep vein thrombosis (DVT) after varicose vein surgery (VVS) is not well recognized. Observational studies have yielded variable estimates of the risk, but evidence from randomized trials is lacking. Our aim was to compare the use of thromboprophylaxis with and without low-molecular-weight heparin (LMWH).
  
  
  METHODS
  We prospectively randomized moderate-risk patients scheduled for VVS in two arms. The first group of patients received bemiparin for 10 days at a prophylactic dose, early ambulation, and compression therapy for 3 months; the second group received early ambulation and compression therapy alone. The primary efficacy outcome was the composite of DVT (symptomatic or asymptomatic detected by mandatory, bilateral duplex scan). Secondary efficacy and primary safety end points were superficial venous thrombosis, postoperative bleeding, and clinical pulmonary embolism (PE). We assessed transient and permanent risk factors for venous thromboembolism.
  
  
  RESULTS
  Two-hundred sixty-two patients were eligible for evaluation. There were no cases of DVT. There were also no cases of clinical PE, death, or major bleeding. No significant differences were seen between groups in the rates of bleeding episodes.
  
  
  CONCLUSIONS
  The data show no superiority of a short-term regimen of LMWH and early ambulation and compression therapy, as compared with early ambulation and compression therapy alone, in patients undergoing VVS in a moderate-risk population.
authors.affiliation: Division of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain. esannorberto@hotmail.com
authors.forename: Enrique María
authors.initials: EM
authors.lastname: San Norberto García
authors.forename: Borja
authors.initials: B
authors.lastname: Merino
authors.forename: James Henry
authors.initials: JH
authors.lastname: Taylor
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Vizcaíno
authors.forename: Carlos
authors.initials: C
authors.lastname: Vaquero
mesh_terms: D000293:Adolescent; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004434:Early Ambulation; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin