title: Bemiparin for thromboprophylaxis after benign gynecologic surgery: a randomized clinical trial.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is the leading cause of mortality and morbidity in women following gynecologic surgery.
  
  
  OBJECTIVE
  To determine the efficacy of a second-generation low molecular weight heparin (bemiparin) for thromboprophylaxis after benign gynecologic surgery.
  
  
  METHODS
  We performed a single-blind randomized controlled trial including women in the moderate-risk, high-risk and highest-risk groups for developing VTE after benign gynecologic surgery. Participants were randomized at a 1 : 1 ratio into parallel groups to receive either seven daily doses of 3500 IU of subcutaneous bemiparin or to a non-intervention group receiving standard rehydration and advice on ambulation. Participants were followed up for 7 days and 30 days postoperatively for symptomatic VTE, which was confirmed by compression Doppler ultrasound, magnetic resonance imaging, or computed tomographic pulmonary angiography, according to the type of VTE.
  
  
  RESULTS
  In total, 387 participants were randomized to the bemiparin group and 387 to the non-intervention group. The incidence of symptomatic VTE (deep vein thrombosis and pulmonary embolism) events was lower (0/377) in participants who received bemiparin than in those who received no pharmacologic intervention (12/380, 3.2%; 95% confidence interval [CI] 0.002-0.6). Logistic regression analysis showed significant associations between VTE and immobility (odds ratio [OR] 7.1; 95% CI 1.3-36.2), varicose veins (OR 16.8; 95% CI 3.1-76.2), and thrombophilia (OR 39.3; 95% CI 1.5-1006.7). There were no major bleeding events or side effects related to the use of bemiparin.
  
  
  CONCLUSIONS
  Bemiparin was an effective thromboprophylactic agent for preventing venous thrombosis after benign gynecologic surgery.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil City, Kurdistan Region, Iraq.
authors.forename: S K
authors.initials: SK
authors.lastname: Alalaf
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil City, Kurdistan Region, Iraq.
authors.forename: A K
authors.initials: AK
authors.lastname: Jawad
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil City, Kurdistan Region, Iraq.
authors.forename: R K
authors.initials: RK
authors.lastname: Jawad
authors.affiliation: Department of Obstetrics and Gynecology, Maternity Teaching Hospital, Hawler Ministry of Health, Erbil City, Kurdistan Region, Iraq.
authors.forename: M S
authors.initials: MS
authors.lastname: Ali
authors.affiliation: Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil City, Kurdistan Region, Iraq.
authors.forename: N G
authors.initials: NG
authors.lastname: Al Tawil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D007493:Iraq / Q000453:epidemiology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin
keywords: bemiparin; clinical trial; gynecologic surgery; pulmonary embolism; venous thromboembolism