title: Perioperative venous thromboembolism in patients with gynecological malignancies: a lesson from four years of recent clinical experience.
abstract: OBJECTIVE
  To analyze clinical characteristics of venous thromboembolisms (VTE) in gynecological malignancies, and to find a cost-effective prophylaxis procedure for post-operative VTE.
  
  
  METHODS
  We analyzed clinical characteristics of 751 patients who underwent definitive surgery for gynecologic malignancies, and cost-effectiveness of VTE prophylaxis.
  
  
  RESULTS
  VTE was diagnosed preoperatively in 4.5% of ovarian cancer cases, more frequently than any other type (p<0.005). Older age and greater length of operation were independent risk factors for postoperative VTE. To prevent eight VTEs in 738 malignant cases, which occurred during day 2 to 10, $617,783, $726,185, or $994,222 were necessary for continuous VTE prophylaxis, using either unfractionated heparin (UFH), low-molecular weight heparin or fondaparinux, respectively.
  
  
  CONCLUSIONS
  A strategy which might be cost-effective for post-surgical management of gynecological malignances is use of UFH three times combined with graduated compression stockings and intermittent pneumatic compression, thorough SpO2 monitoring, and perioperative measurements of the circumference of both sides of thighs and calves.
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Akiko
authors: A
authors: Morimoto
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan ZVF03563@nifty.ne.jp.
authors: Yutaka
authors: Y
authors: Ueda
authors: Department of Obstetrics and Gynecology, Kaizuka City Hospital, Kaizuka, Osaka, Japan.
authors: Takeshi
authors: T
authors: Yokoi
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Yuki
authors: Y
authors: Tokizawa
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Kiyoshi
authors: K
authors: Yoshino
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Masami
authors: M
authors: Fujita
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Toshihiro
authors: T
authors: Kimura
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Eiji
authors: E
authors: Kobayashi
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Shinya
authors: S
authors: Matsuzaki
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Tomomi
authors: T
authors: Egawa-Takata
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Kenjiro
authors: K
authors: Sawada
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Tateki
authors: T
authors: Tsutsui
authors: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Yamadaoka, Suita, Osaka, Japan.
authors: Tadashi
authors: T
authors: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D000077425:Fondaparinux; D005833:Genital Neoplasms, Female / Q000097:blood / Q000191:economics / Q000601:surgery*; D006493:Heparin / Q000008:administration & dosage* / Q000191:economics; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D007564:Japan; D008875:Middle Aged; D059035:Perioperative Period; D011134:Polysaccharides / Q000008:administration & dosage / Q000191:economics; D054556:Venous Thromboembolism / Q000191:economics / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux
keywords: Economic comparison; UFH; VTE; fondaparinux; gynecological malignancy; post-operative; prophylaxis; short duration