Publication: 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
Issued Date
2021-12-01
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ISSN
01252208
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2-s2.0-85122623887
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol.104, No.12 (2021), S1-S9
Suggested Citation
Nutsiri Kittitirapong, Parach Sirisriro, Wiwat Tirapanich, Sopon Jirasiritum, Surasak Leela-Udomlipi, Suthas Horsirimanont, Chumpon Wilasrsamee, Chairat Supsamutchai, Pitichote Hiranyatheb, Samart Phuwapraisirisan, Jakrapun Jirasiritum, Preeda Sumritpradit, Tharin Thampongsa, Pongsasit Singhatas, Piyanut Pootracool 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. Journal of the Medical Association of Thailand. Vol.104, No.12 (2021), S1-S9. doi:10.35755/jmedassocthai.2021.S05.00061 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77427
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Title
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
Author(s)
Nutsiri Kittitirapong
Parach Sirisriro
Wiwat Tirapanich
Sopon Jirasiritum
Surasak Leela-Udomlipi
Suthas Horsirimanont
Chumpon Wilasrsamee
Chairat Supsamutchai
Pitichote Hiranyatheb
Samart Phuwapraisirisan
Jakrapun Jirasiritum
Preeda Sumritpradit
Tharin Thampongsa
Pongsasit Singhatas
Piyanut Pootracool
Parach Sirisriro
Wiwat Tirapanich
Sopon Jirasiritum
Surasak Leela-Udomlipi
Suthas Horsirimanont
Chumpon Wilasrsamee
Chairat Supsamutchai
Pitichote Hiranyatheb
Samart Phuwapraisirisan
Jakrapun Jirasiritum
Preeda Sumritpradit
Tharin Thampongsa
Pongsasit Singhatas
Piyanut Pootracool
Other Contributor(s)
Abstract
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.