Intervention Review

Heparins and mechanical methods for thromboprophylaxis in colorectal surgery

  1. Peer Wille-Jørgensen1,*,
  2. Morten Schnack Rasmussen2,
  3. Betina Ristorp Andersen3,
  4. Lars Borly4

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 27 AUG 2003

DOI: 10.1002/14651858.CD001217


How to Cite

Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD001217. DOI: 10.1002/14651858.CD001217.

Author Information

  1. 1

    Bispebjerg Hospital, Department of Surgical Gastroenterology K, Copenhagen NV, Denmark

  2. 2

    H:S Bispebjerg Hospital, Surgical gastroenterology dept. K, Copenhagen, Denmark

  3. 3

    Hillerød University Hospital, Department of Obstetrics and Gynecology, Hillerød, Denmark

  4. 4

    Næstved University Hospital, Department of Obstetrics and Gynecology, Næstved, Denmark

*Peer Wille-Jørgensen, Department of Surgical Gastroenterology K, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen NV, DK-2400, Denmark. pwj01@bbh.regionh.dk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JAN 2004

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Colorectal surgery implies higher risk of postoperative thromboembolic complications as deep venous thrombosis (DVT) and pulmonary embolism (PE) than general surgery. The best prophylaxis in general surgery is heparin and graded compression stockings. No systematic review on combination prophylaxis or on thrombosis prophylaxis in colorectal surgery has been published.

Objectives

To compare the incidence of postoperative thromboembolism after colorectal surgery using prophylactic methods focussing on heparins and mechanical methods alone and in combinations.

Search methods

Electronic searches was performed in PUBMED, EMBASE, LILACS and the Cochrane Library. Abstract books from major congresses were handsearched as were reference lists from previously performed reviews.

Selection criteria

RCT or CCT comparing prophylactic interventions and/or placebo. Outcomes were ascending venography, 125 I-fibrinogen uptake test, ultrasound methods, pulmonary scintigraphy. Studies, using thermographic methods, other isotopic methods, plethysmographic methods, and purely clinical methods as the only diagnostic measure were excluded. 558 studies were identified - 477 were excluded. Only 3 of the identified studies focused exclusively on colorectal surgery. Studies of general surgery contain considerable numbers of colorectal patients. The authors of 66 studies in general and/or abdominal surgery were contacted for retrieving the results from the colorectal patients. Answers were received from very few. 19 studies entered this review.

Data collection and analysis

All studies and all data extraction were performed by at least two of the authors. Outcome was deep venous thrombosis and/or pulmonary embolism. Analysis of bleeding complications were unfeasible. 12 meaningful outcomes were analysed by means of the fixed effects model with Peto Odds Ratios.

Main results

Heparins versus no treatment: Any kind of heparincompared to no treatment or placebo (comparison 07.03, 11 studies). Heparin is better in preventing DVT and/or PE with a Peto Odds ratio at 0.32 (95% Confidence Interval 0.20-0.53)
Unfractionated heparin versus low molecular weight heparin (comparison 08.03, 4 studies). The two treatments were found equally effective in preventing DVT and/or PE with a Peto Odds ratio 1.01 (95% Confidence Interval 0.67-1.52).
Mechanical methods (comparison 10.3, 2 studies).The combination of graded compression stockings and LDH is better than LDH alone in preventing DVT and/or PE with a Peto Odds ratio at 4.17 (95% Confidence Interval 1.37-12.70).

Authors' conclusions

The optimal prophylaxis in colorectal surgery is the combination of graduated compression stockings and low-dose unfractionated heparin. The unfractionated heparin can be replaced with low molecular weight heparin.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

A combination of graduated compression stockings and heparin seems to be the optimal prophylaxis for patients undergoing colorectal surgery.

Patients undergoing surgery of the large bowel and the rectum have a considerable risk of developing vascular complications expressed as venous thrombosis and/or thrombosis in the lungs (pulmonary embolism). These complications can lead to lifelong impaired venous function in the legs or occasionally sudden postoperative death. In order to avoid these complications, patients are often treated with blood-thinning medicine (anticoagulation) and graded compression stockings during operation. A combination treatment of Heparin and TED-stockings have been proved effective in general surgery. This review demonstrates that this combined treatment also is effective within the high-risk group of patients undergoing surgery of the large bowel or rectum.