Thromboprophylaxis in gynaecology: a review of current evidence TOG 2022

Question 1

What proportion of VTE is hospital acquired?

Answer 1

50-60%

Question 2

Without prophyalxsis risk of VTE following major abdominal sugery>

Answer 2

17-40%

Question 3

After surgery how long does the increased risk of VTE last?

Answer 3

12 weeks
Peak at 6 weeks

Question 4

What is considered a hospital associated thrombosis

Answer 4

Occurring within or 90 days after hospital admission

Accounts for 50-60% of all VTE events

Question 5

Explain Virchows triad

Answer 5

Question 6

Which women should be considered for LMWH from 1st trimest

Answer 6

Previous VTE
Or total score equal/more than 4

Question 7

Causes of VTE in hyperemesis

Answer 7

Dehydration/haemoconcentration
Immobility

Question 8

How much does
1) IVF
2) IVF + OHSS
increase VTE risk?

Answer 8

IVF - 5 X
IVF + OHSS 100 x

Question 9

In severe OHSS when can LMWH be stopped?

Answer 9

In OHSS, LMWH throughout 1st trimester.
Or if no pregnancy until withdrawal bleed.

Question 10

Should VTE be calculated following treatment of miscarriage or ectopic?

Answer 10

Yes!

E.g. If surgical treatment in pregnancy & perineum has VTE score 3 and 10 days LMWH should be consider e.g. surgical management of ectopic

Question 11

What are the risk factors for VTE following gynaecological surgery?

Answer 11

Question 12

Incidence of VTE
- Pregnancy
- Postpartum
- COCP
- Outside preg

Quotes as /10,000

Answer 12

• Pregnancy 2-20
• Postpartum 40-65
• COCP 3-14
• Outside preg 1-5

/10,000

Question 13

After stopping COCP how long does risk of VTE remain increased? When should stopped & started after surgery

Answer 13

4-6 weeks

Stop 4 weeks before
Restart at least 2 weeks after, could offer POP as altnerativr

Question 14

Which HRT has highest & lowest risk of VTE

Answer 14

Lower with transdermal estradiol. Higher with oral.

Lowest: Estradiol-medroxyprogesterone

Maximum - conjugated equine estrogen-medroxyprogesterone acetate

Question 15

Do you need to stop HRT pre-op?

Answer 15

No

Question 16

Prevention methods for VTE

Answer 16

• Early ambulation
• Compression stocking -greater pressure at ankle than knee
  o CI peripheral vascular disease, arterial bypass grafting, peripheral neuropathy, dermatitis, leg odeama
• IPC reduced DVT 60%
  o CI odema from HF, cellulitis, DVT, sig arterial insufficiency
• LMWH – renally cleared, lower risk HIT, 40% reduced VTE
  o Active bleeding, high risk bleeding
• Unfractioned Herparin – not renally cleared
  o HIT, osteoporosis

Question 17

VTE risk in early pregnancy flow digram

Answer 17

Question 18

VTE risk assessment for patients undergoing gynae surgery

Answer 18