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. |
