Abstract
Background: Although thromboprophylaxis is recommended to reduce death and disability from venous thromboembolism (VTE), it remains underused due to a perceived risk of bleeding, especially in major abdominopelvic surgical patients. Methods: We conducted a systematic literature review to identify all eligible randomised controlled trials (RCTs), searching MEDLINE and Scopus databases through September 30, 2019. Inclusion criteria comprised population (gynaecological cancer patients undergoing surgery) and mechanical and pharmacological intervention comparisons. Outcomes of interest were composite VTE and major bleeding. Relevant data were extracted for direct and network meta-analyses. Risk ratios (RR) and 95% confidence interval (CI) were estimated and the best intervention probability calculated for each outcome. This study was registered with PROSPERO (CRD42019145508). Findings: We identified 1955 studies. Twenty RCTs (4970 patients) were eligible. The risk of bias was of some concerns. In direct meta-analyses, antithrombins were superior to unfractionated heparin in preventing composite VTE (RR 0·69; 95% CI 0·48-0·99), with no difference detected in the rate of major bleeding for any pairwise comparisons. In network meta-analyses, graduated compression stockings plus low-molecular-weight heparin (LMWH) was top-ranked for prevention of composite VTE, whereas sequential compression devices (SCD) ranked second, after no treatment, for major bleeding. In a clustered ranking plot, SCD plus LMWH provided optimal balance between efficacy and safety. Interpretation: Although SCD plus LMWH was safe and effective in VTE prevention following gynaecological cancer surgery, no single prophylactic method was considered superior in all aspects. Thus, clinicians should consider the patient’s bleeding risk and preference, and cost-effectiveness. Funding Statement: There was no funding source for this study. Declaration of Interests: We declare no competing interest.
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