Low-Molecular-Weight Heparin Versus Unfractionated Heparin As Thromboprophylaxis In Patients Undergoing Colorectal Surgery
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Background : Colorectal surgery carries a high risk of venous thromboembolism world-wide. The need of effective and safe thrombo-prophylazis is a matter of continuous investigation. Objective: To compare the effectiveness and safety of low-dose unfractionated heparin and a low-molecular weight heparin as prophylaxis against venous thromboembolism after colorectal surgery. Patients te Methods : Patients undergoing resection of part or all of the colon or rectum were randomized to receive, by subcutaneous injection, either calcium heparin 5,000 units every 8 hours or enoxaparin 40 mg once daily. Deep vein, thrombosis was assessed by routine bilateral high resolution color flow duplex imaging performed between postoperative day Sand 9, or earlier if clinically suspected. Results : Two hundreds and eight randomized patients completed the protocol and had an adequate outcome assessment. The benous thromboembolism rates were similar in both groups. There were no deaths front pulmonary embolism or bleeding complications. Although the proportion of all bleeding events in the enoxaparin group was significantly greater than in the low-dose heparin group, the rates of major bleeding and re-operation for bleeding were not significantly different. Conclusions: Both heparin 5,000 units subcutaneously every 8 hours and enoxaparin 40 mg subcutaneously once daily provide highly effective and safe prophylaxis for patients undergoing colorectal surgery. However given the current differences in cost, prophylaxis with low-dose heparin remains the preferred method at preset' t.