Outcomes Comparison between Low Molecular-Weight Heparin with Mechanical Prophylaxis versus Mechanical Prophylaxis Alone for Perioperative Venous Thromboembolism Prevention in Abdominopelvic Surgery: A Randomized Controlled Trial

Nutsiri Kittitirapong¹, Parach Sirisriro¹, Wiwat Tirapanich¹, Sopon Jirasiritum¹, Surasak Leela-Udomlipi¹, Suthas Horsirimanont¹, Chumpon Wilasrsamee², Chairat Supsamutchai², Pitichote Hiranyatheb², Samart Phuwapraisirisan², Jakrapun Jirasiritum², Preeda Sumritpradit³, Tharin Thampongsa³, Pongsasit Singhatas³, Piyanut Pootracool¹

Affiliation : ¹ Division of Vascular Surgery, Department of Surgery,


Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok,


Thailand, ² Division of General Surgery, Department of


Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University,


Bangkok, Thailand, ³ Division of Trauma and Surgical Critical


Care, Department of Surgery, Faculty of Medicine Ramathibodi Hospital,


Mahidol University, Bangkok, Thailand

Background: Pharmaco-mechanical prophylaxis has been recommended for venous thromboembolism (VTE) prevention in surgical patients. The rate of receiving pharmacological prophylaxis was low due to the bleeding concern. The mechanical prophylaxis; either intermittent pneumatic compression (IPC) or graduated compressive stocking (GCS), becomes a preferred method, although its VTE incidence was higher than pharmaco-mechanical prophylaxis. The combination of IPC and GCS had a lower risk of DVT than GCS alone. We examined the efficacy of combining mechanical prophylactic methods; IPC and GCS, in VTE prophylaxis.
Objective: The present study aimed to compare the pharmaco-mechanical method with combining mechanical method in VTE prophylactic effectiveness and adverse events for elective abdominopelvic surgery.
Materials and Methods: A randomized controlled trial was conducted in elective abdominopelvic surgical patients. The control group received low molecular weight heparin, IPC, and GCS, whereas the study group received IPC and GCS.
Results: We enrolled 76 elective abdominopelvic surgical patients, 39 patients in the control group, and 37 patients in the study group. Surgery for cancer was accounted for 64 (84.2%) and Caprini score was 8.4 (±1.95). The incidence of perioperative VTE was 5 (6.58%). All VTE cases were asymptomatic DVT. In the present study group, 1 (2.7%) of proximal DVT and 3 (8.1%) of calf vein DVT occurred. Only 1 (2.6%) of proximal DVT occurred in the control group. The incidence of VTE tended to be higher in the present study group than in the control group; 4 (10.8%) vs. 1 (2.6%); RR 4.22, 95% CI 0.49 to 36.00, p-value=0.194). The adverse event such as symptomatic pulmonary embolism (PE), bleeding complication, and readmission rate was not found.
Conclusion: The effectiveness of IPC combined with GCS was not superior to pharmaco-mechanical thromboprophylaxis for VTE prevention in high-risk surgical patients.

doi.org/10.35755/jmedassocthai.2021.S05.00061

Keywords : VTE cancer surgery, DVT prophylaxis, VTE prophylaxis, DVT, PE, Deep vein thrombosis, Pulmonary embolism,


mechanical thromboprophylaxis, Intermittent pneumatic compression (IPC), Graduated compression stockings (GCS)

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