PB 232: Prevention of Venous Thromboembolism in Gynecologic Surgery Flashcards
What is the rate of VTE after gyn surgery in the absence of thromboprophylaxis?
15-40%
What are risk factors for VTE in gynecologic surgery?
What type of thromboprophylaxis is recommended based on Caprini score?
What are the recommended thromboprophylaxis options for gynecologic surgery patients at LOW risk of VTE?
Mechanical thromboprophylaxis (preferably intermittent pneumatic compression) is recommended; graduated compression stocks are a reasonable alternative.
SCDs, when used before and after surgery, are as effective as low dose unfractionated heparin (LDUH) and low molecular weight heparin (LMWH) in reducing DVT incidence.
What are the recommended thromboprophylaxis options for gynecologic surgery patients at MODERATE risk of VTE?
Mechanical thromboprophylaxis (SCDs) OR pharmacological thromboprophylaxis with LDUH or LMWH)
What are the advantages of low dose unfractionated heparin (LDUH)?
Well studied
Low cost
Minimally excreted by kidneys and can safely be used in patients with renal insufficiency
Rapid onset of action
Readily reversed with protamine sulfate
What are the advantages of LMWH?
Less frequent administration
Greater bioavailability
Longer half life
Decreased risk of HIT
More antifactor Xa and less AT3 activity which may decrease the risk of major bleeding and hematoma formation
What are the recommended thromboprophylaxis options for gynecologic surgery patients at HIGH risk of VTE?
DUAL thromboprophylaxis with a combination of mechanical thromboprophylaxis (SCDs) AND pharmacological thromboprophylaxis with LDUH or LMWH)
True or False: Routine thrombophilia testing should be performed for patients who experience VTE in the perioperative period
FALSE
In this setting, assessment of patient risk factors (concurrent hormone exposure) and family history are recommended.
For patients with additional risk factors for thrombophilia, VTE, or both, referral to a specialist in thromboembolic disorders should be considered.
Should all patients stop combined hormonal contraceptives prior to surgery?
No
Only those undergoing major surgery with anticipated prolonged immobilization. The estrogenic component of COCs increases hepatic coagulation (including factors VII, factor X, and fibrinogen) and increases risk of VTE.
The normalization of clotting factors associated with stopping COCs is not observed unless discontinuation happens 4-6 weeks before major surgery.
Should menopausal women stop hormone replacement therapy prior to gynecologic surgery?
Decisions regarding stopping HRT should be individualized based on clinical risk factors and shared patient-physician decision making. HRT is associated with an increased risk of VTE, although the absolute incidence is low.
How long should one wait to place neuraxial anesthesia after receiving LMWH prophylaxis? LDUH prophylaxis?
When can prophylaxis be resumed after neuraxial catheter removal?
Wait times for neuraxial anesthesia placement after prophylaxis administration
- LMWH: 12 hours
- LDUH: 4-6 hours
Wait time for prophylaxis administration after neuraxial catheter removal
- LMWH: 4 hours
- LDUH: can be administered immediately
