PMID- 15863537
OWN - NLM
STAT- MEDLINE
DCOM- 20050630
LR  - 20131121
IS  - 0029-7844 (Print)
IS  - 0029-7844 (Linking)
VI  - 105
IP  - 5 Pt 1
DP  - 2005 May
TI  - Low-molecular-weight heparin (dalteparin) in women with gynecologic malignancy.
PG  - 1006-11
AB  - OBJECTIVE: To compare the efficacy of dalteparin, a low-molecular-weight heparin, 
      to unfractionated heparin (UFH) in the prevention of deep venous thrombosis (DVT) 
      and pulmonary embolism in patients after surgery for gynecologic malignancy. 
      METHODS: The medical records of all patients undergoing major surgery on the 
      Gynecologic Oncology Service at the Massachusetts General Hospital from July 2002 
      through April 2003 were reviewed. Patients with confirmed malignancy were 
      included. Between July 1, 2002, and November 15, 2002, dalteparin (5,000 U 
      subcutaneously each day) was used for postoperative prophylaxis for DVT and 
      pulmonary embolus. After November 15, 2002, the method of prophylaxis was changed 
      to UFH (5,000 U subcutaneously every 8 hours) exclusively. Patients were 
      evaluated for DVT or pulmonary embolus based on clinical suspicion using computed 
      tomographic angiography, ventilation and perfusion scan, or lower extremity 
      doppler. RESULTS: A total of 214 patients were identified who met study criteria. 
      Dalteparin was administered to 103 patients, and UFH was administered to 111. The 
      rates of clinically significant DVT or pulmonary embolus in patients receiving 
      dalteparin and UFH were 8.9% and 1.2%, respectively (P = .009). Major risk 
      factors for DVT or pulmonary embolus, including age, obesity, duration of 
      surgery, and type of malignancy, did not differ between groups. There were no 
      significant differences in bleeding complications or transfusion requirements 
      between groups. CONCLUSION: The low-molecular-weight heparin dalteparin dosed 
      5,000 U daily is inadequate postoperative prophylaxis in women undergoing surgery 
      for gynecologic cancer. In addition, heparin administered every 8 hours was not 
      associated with increased bleeding complications. The use of dalteparin at the 
      doses used in this study should be questioned until a large randomized trial 
      shows efficacy in these high-risk patients.
FAU - DeBernardo, Robert L Jr
AU  - DeBernardo RL Jr
AD  - Divisions of Gynecologic Oncology and Medical Oncology, Massachusetts General 
      Hospital, Boston, Massachusetts, USA.
FAU - Perkins, Rebecca B
AU  - Perkins RB
FAU - Littell, Ramey D
AU  - Littell RD
FAU - Krasner, Carolyn N
AU  - Krasner CN
FAU - Duska, Linda R
AU  - Duska LR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Adult
MH  - Age Distribution
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Dalteparin/*administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Follow-Up Studies
MH  - Genital Neoplasms, Female/pathology/*surgery
MH  - Gynecologic Surgical Procedures/adverse effects/methods
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Incidence
MH  - Injections, Subcutaneous
MH  - Middle Aged
MH  - Perioperative Care
MH  - Probability
MH  - Prospective Studies
MH  - Pulmonary Embolism/epidemiology/*prevention & control
MH  - Risk Assessment
MH  - Sex Distribution
MH  - Treatment Outcome
MH  - Venous Thrombosis/epidemiology/*prevention & control
EDAT- 2005/05/03 09:00
MHDA- 2005/07/01 09:00
CRDT- 2005/05/03 09:00
PHST- 2005/05/03 09:00 [pubmed]
PHST- 2005/07/01 09:00 [medline]
PHST- 2005/05/03 09:00 [entrez]
AID - 105/5/1006 [pii]
AID - 10.1097/01.AOG.0000153026.61249.c7 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2005 May;105(5 Pt 1):1006-11. doi: 
      10.1097/01.AOG.0000153026.61249.c7.