Thromboprophylaxis in patients undergoing colorectal surgery
Abstract
Aim: To compare the reviparin and enoxaparin thromboprophylaxis in patients undergoing colorectal surgery. Methods: We have prospectively analyzed 97 patients who had undergone colorectal surgery for colon malignancy at the Department for Abdominal Surgery II, Dubrava University Hospital, Zagreb, Croatia, for two years period (January 1st 2003−December 31st 2004). Reviparin was used in 2003 for thromboprophylaxis, and in 2004 enoxaparin was used. The blood coagulation parameters preoperatively, duration of thromboprophylaxis, incidence of the thromboembolic diseases, deep venous thrombosis and pulmonary embolism, and mortality were analyzed. Results: In year 2003, 55 patients underwent surgery for colorectal carcinoma. The reviparin was used for thromboprophylaxis in 54 (98.18%) patients and another patient had wafarin in therapy because of earlier cardiac surgery. Median thromboprophylaxis length was 9.56 days (range 3−25). In year 2004, 42 patients underwent surgery. The enoxaparin was used for thromboprophylaxis in 42 (97.62%) patients and another patient had no prophylaxis. Median thromboprophylaxis length was 8.46 days (range 3−27). The mortality rate for both years was 5.15% (five patients) and one patient died because of pulmonary embolism in year 2003. In another four patients the cause of death were not thromboembolic complications, but cardiorespiratory insufficience of patients with terminal-stage cancer. Conclusion: Due to morbidity and mortality of pulmonary embolism and deep venous thrombosis, patients undergoing colorectal surgery should have thromboprophylaxis. The low-molecular weight heparin is a recommended alternative to unfractionated heparin because it may offer increased efficacy without increasing the bleeding risk. We can recommend enoxaparin in 40 mg subcutaneous single dose through seven days.
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