BACKGROUND: The reported overall risk of @entity1150 in gynaecological surgery ranges from 7 to 45%. Fatal @entity1151 is estimated to occur in nearly 1% of these @entity1 . Pharmaceutical interventions are one possible prophylactic measure for preventing @entity999 in @entity1 undergoing major gynaecological surgery. Agents include unfractionated heparin (low -dose and adjusted-dose), low-molecular-weight heparins, heparinoids and @entity1229 . OBJECTIVES: The objective of this review was to evaluate the effectiveness of @entity1229 , heparin and @entity117 in preventing @entity1031 after major gynaecological surgery. SEARCH STRATEGY: We searched the Cochrane @entity1866 and Subfertility Group trials register (searched 15 August 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library issue 2, 2003), MEDLINE (1966 to April 2003), EMBASE (1985 to April 2003), and CINAHL (1982 to April 2003). References from relevant articles were searched and authors contacted where necessary. In addition we contacted experts in the field for unpublished works. SELECTION CRITERIA: Randomised controlled trials of heparins, @entity1229 or @entity117 to prevent @entity1031 after major gynaecological surgery were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Thirty-three trials were identified in the initial search. On careful inspection only eight of these met the inclusion criteria. Trials were data extracted and assessed for quality by at least two reviewers. Data were combined for meta-analysis using odds ratios for dichotomous data or weighted mean difference for continuous data. A random effects statistical model was used. MAIN RESULTS: The meta-analysis of heparin versus placebo found a statistically significant decrease in the number of DVTs in both the all @entity1 group (including those with and without @entity5 ) (OR 0.30, 95% CI 0.12 to 0.76) and the subgroup of only @entity1 with @entity5 (OR 0.30, 95% CI 0.10 to 0.89). There was no significant difference in the incidence of PE. Oral @entity1229 reduced @entity11942 when compared to placebo in all @entity1 (OR 0.22, 95% CI 0.06 to 0.86) and in @entity1 with @entity5 (OR 0.18, 95% CI 0.04 to 0.87). Meta-analyses of UH and LMWH showed no statistical difference in any comparison. No studies compared @entity117 alone to placebo, heparin or @entity1229 . There was a statistically significant increase in injection site haematomas associated with heparin compared to placebo (OR 0.30, 95% CI 0.10 to 0.89). REVIEWER'S CONCLUSIONS: @entity1 , undergoing major gynaecological surgery and without contraindications to anticoagulants should be offered thromboprophylaxis. Evidence suggests that UH and LMWH are equally as effective in preventing @entity11942 and the one trial available suggests that @entity1229 is as effective as UH. There is no evidence as yet to suggest that @entity1229 , heparin or @entity117 reduce incidence of PE.

Anticoagulant and XXXX prophylaxis for preventing @entity1031 after major gynaecological surgery.

@entity1 :: ('9606', 'Species') :: ['women', 'Women'] @entity5 :: ('MESH:D009369', 'Disease') :: ['malignancy'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity999 :: ('MESH:D020766', 'Disease') :: ['emboli'] @entity1151 :: ('MESH:D011655', 'Disease') :: ['pulmonary embolism'] @entity1150 :: ('MESH:D020246', 'Disease') :: ['deep venous thrombosis'] @entity1866 :: ('MESH:D008599', 'Disease') :: ['Menstrual Disorders'] @entity1031 :: ('MESH:D013923', 'Disease') :: ['thromboembolism'] @entity1229 :: ('MESH:D014859', 'Chemical') :: ['warfarin'] @entity11942 :: ('OMIM:612862', 'Disease') :: ['DVT']
@entity117 :: (MESH:D001241,Chemical) :: ['aspirin']
