Perioperative intervention to prevent lower extremity deep venous thrombosis after gynecologic surgery

Abstract

To investigate the preventative effect of perioperative intervention to lower extremity deep venous thrombosis (DVT) after gynecologic surgery. The 1062 patients,who received gynecologic surgery during 2007 June to 2008 June, were divided into intervention and nonintervention groups randomizely. According to the risk factors of DVT, the patients in intervention group were divided into 4 subgroups: low, mid, high and extremely high risk. Each group had its own preventive measures. If patients had spontaneous pain, tenderness and swelling, positivity of Neuhof or Homan syndrome, and extension of one low extremity superficial vein, the low extremity color Doppler ultrasound would be carried out immediately. The ultrasound would also be routinely carried out in the high and extremely high risk groups in intervention group after 2 and 7 days after surgery. A prospective study was carried out investigating incidence of DVT and coagulation function perioperation. The vein blood samples were taken at in a week before surgery and 48 hours post-operation. The incidence of DVT of intervention group was 1.10% (6/546), and in nonintervention group, the incidence was 3.29% (17/516). There was significant difference between two groups (P < 0.05). The incidence of DVT in extremely high risk subgroup was 21.05% (4/19), which was significantly higher than that of low(0), mid(0)and high risk groups [2.13% (2/94), P < 0.05]. D-dimer, antithrombin-III (AT-III) post-operation were all higher than that pre-operation in the two groups, but there was no significant difference (P > 0.05). The indexes of coagulation system,such as blood platelet count, prothrombin time (PT), active partial thromboplastin time (APTT), fibrinogen (Fbg), thrombin time (TT), tissue-plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), were not significantly changed perioperation (P > 0.05 in all pre-or post-operation indexes). Perioperative intervention measurement according to different risk of DVT could cut down the incidence of DVT. DVT preventive intervention is suggested to high and extremely high risk people.