HomeArticles2022 No.2Details

Low molecular weight heparin plus physiotherapy techniques in prevention of deep vein thrombosis in gynecological cancer patients undergoing major abdominopelvic surgery: a network Meta-analysis

Update:Apr. 25, 2022Total Views:1201Total Downloads:1140 DownloadMobile

Author: Shu-Ting YAO 1 Jin-Zhu YAN 1 Yu-Fang KE 1 Ming-Hua CUI 1 Chao ZHANG 2 Cai-Yun FANG 1

Affiliation: 1. Department of Gynaecology and Obstetrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China 2. Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China

Keywords: Low molecular weight heparin Gynecological cancer Deep vein thrombosis Abdom-inopelvic surgery Network Meta-analysis


Reference:Yao ST, Yan JZ, Ke YF, Cui MH, Zhang C, Fang CY. Low molecular weight heparin plus physiotherapy techniques in prevention of deep vein thrombosis in gynecological cancer patients undergoing major abdominopelvic surgery: a network Meta-analysis[J]. Yixue Xinzhi Zazhi, 2022, 32(2): 108-119. DOI: 10.12173/j.issn.1004-5511.202109007.[Article in Chinese]

  • Abstract
  • Full-text
  • Figures and Tables
  • References

Objective  To systematically review the efficacy and safety of low molecular weight heparin (LMWH) plus physiotherapy techniques in the prevention of deep vein thrombosis (DVT) among gynecological cancer patients undergoing major abdominopelvic surgery using a network analysis. 

Methods  We electronically searched PubMed, The Cochrane Library, Embase, Web of Science, Wan-Fang Data and CNIK for randomized controlled trials (RCTs) on the efficacy and safety of LMWH plus mechanical methods for prevention DVT in gynecological cancer patients undergoing major abdom-inopelivc surgery. The duration of search was from the inception of the databases to March 2021. After literature selection, data extraction and quality assessment was conducted by two reviewers inde-pendently; and network Meta-analysis was conducted using Stata 14.0 and RevMan 5.4 software. 

Results  A total of 21 RCTs involving 4,145 patients were included. Network Meta-analysis showed that LMWH plus graduated compression stockings (GCS) or sequential compression devices (SCD) was superior to drug or physical in-tervention alone in the prevention DVT, and there was no statistically significant difference in the efficacy between LMWH plus GCS or SCD. LMWH had a similar incidence of DVT and major bleeding events compared with unfraction-ated heparin (UH). 

Conclusion  LMWH plus GCS or SCD was top-ranked for prevention of DVT, for major bleeding events LMWH was similar to UH. The above conclusions are limited by the number and quality of included studies, and need to be verified by more high-quality and multicenter studies.

Please download the PDF version to read the full text: download

1.Timp JF, Braekkan SK, Versteeg HH, et al. Epidemiology of cancer-associated venous thrombosis[J]. Blood, 2013, 122(10): 1712-1723. DOI: 10.1182/blood-2013-04-46 0121.

2.Cohen AT, Katholing A, Rietbrock S, et al. Epidemiology of first and recurrent venous thromboembolism in patients with active cancer. A population-based cohort study[J]. Thromb Haemost, 2017, 117(1): 57-65. DOI: 10.1160/TH 15-08-0686.

3.Heit JA, Silverstein MD, Mohr DN, et al. Risk factors for deep vein thrombosis and pulmo-nary embolism: a population-based case-control study[J]. Arch Intern Med, 2000, 160(6): 809-815. DOI: 10.1001/archinte.160.6.809.

4.Sevestre MA, Soudet S. Epidemiology and risk factors for cancer-associated thrombosis[J]. J Med Vasc, 2020, 45(6S): 6S3-6S7. DOI: 10.1016/S2542-4513(20)30513-7.

5.Barber EL, Clarke-Pearson DL. Prevention of venous thromboembolism in gynecologic on-cology surgery[J]. Gynecol Oncol, 2017, 144(2): 420-427. DOI: 10.1016/j. ygyno.2016.11.036.

6.Kumar DR, Hanlin E, Glurich I, et al. Virchow's contribution to the understanding of throm-bosis and cellular biology[J]. Clin Med Res, 2010, 8(3-4): 168-172. DOI: 10.3121/cmr.2009.866.

7.Streiff MB, Holmstrom B, Angelini D, et al. Cancer-associated venous thromboembolic dis-ease, Version 2. 2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(10): 1181-1201. DOI: 10.6004/jnccn.2021.0047.

8.The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. Version 5.1.0[EB/OL]. (2011-03) [2021-10-12]. https://training.cochrane.org/handbook/archive/v5.1/.

9.张超, 鄢金柱, 孙凤, 等. 网状Meta分析一致性的鉴别与处理方法[J]. 中国循证医学杂志, 2014, 14(7): 884-888. [Zhang C, Yan JZ, Sun F, et al. Differentiation and handling of homogeneity in net-work meta-analysis[J]. Chinese Journal of Evidence-Based Medicine, 2014, 14(7): 884-888.] DOI: 10.7507/1672-2531.20140146.

10.Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for pre-senting results from multiple-treatment meta-analysis: an overview and tutorial[J]. J Clin Ep-idemiol, 2011, 64(2): 163-171. DOI: 10.1016/j.jclinepi.2010.03.016.

11.曾宪涛, 张超, 邝心颖, 等. 基于使用的网状Meta分析软件的比较研究与选择[J]. 中国循证医学杂志, 2014, 14(10): 1270-1275. [Zeng XT, Zhang C, Kuang XY, et al. Software for network Me-ta-analysis: a usage-based comparative study[J]. Chinese Journal of Evidence-Based Medi-cine, 2014, 14(10): 1270-1275.] DOI: 10.7507/1672-2531.20140204.

12.Fricker JP, Vergnes Y, Schach R, et al. Low dose heparin versus low molecular weight hepa-rin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery[J]. Eur J Clin Invest, 1988, 18(6): 561-567. DOI: 10.1111/j.1365-2362.1988.tb01268.x.

13.Samama M, Bernard P, Bonnardot JP, et al. Low molecular weight heparin compared with unfractionated heparin in prevention of postoperative thrombosis[J]. Br J Surg, 1988, 75(2): 128-131. DOI: 10.1002/bjs.1800750213.

14.von Tempelhoff GF, Dietrich M, Niemann F, et al. Blood coagulation and thrombosis in pa-tients with ovarian malignancy[J]. Thromb Haemost, 1997, 77(3): 456-461. DOI: 10.1055/s-0038-1655988.

15.Ward B, Pradhan S. Comparison of low molecular weight heparin (Fragmin) with sodium heparin for prophylaxis against postoperative thrombosis in women undergoing major gy-naecological surgery[J]. Aust N Z J Obstet Gynaecol, 1998, 38(1): 91-92. DOI: 10.1111/j.1479-828x.1998.tb02 968.x.

16.Baykal C, Al A, Demirtaş E, et al. Comparison of enoxaparin and standard heparin in gy-naecologic oncologic surgery: a randomised prospective double-blind clinical study[J]. Eur J Gynaecol Oncol, 2001, 22(2): 127-130. DOI: 10.1016/S0959-8049(00)00373-7.

17.Maxwell GL, Synan I, Dodge R, et al. Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial[J]. Obstet Gynecol, 2001, 98(6): 989-995. DOI: 10.1016/S0029-7844(01)01601-5.

18.Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thrombo-embolism with enoxaparin after surgery for cancer[J]. N Engl J Med, 2002, 346(13): 975-980. DOI: 10.1056/NEJMoa012385.

19.Nagata C, Tanabe H, Takakura S, et al. Randomized controlled trial of enoxaparin versus intermittent pneumatic compression for venous thromboembolism prevention in Japanese surgical patients with gynecologic malignancy[J]. J Obstet Gynaecol Res, 2015, 41(9): 1440-1448. DOI: 10.1111/jog.12740.

20.郑虹, 高雨农, 燕鑫, 等. 术后应用低分子肝素联合逐级加压弹力袜预防妇科恶性肿瘤患者静脉血栓栓塞性疾病 [J] . 中华肿瘤杂志, 2014, 36(1): 39-42. [Zheng H, Gao YN, Yan X, et al. Prophylactic use of low molecular weight heparin in combination with graduated compression stockings in post-operative patients with gynecologic cancer[J]. Chinese Journal of Oncology, 2014, 36(1): 39-42.] DOI: 10.3760/cma.j.issn.0253-3766.2014.01.009.

21.龚姗, 金海红, 姜丽, 等. 妇科恶性肿瘤患者腹腔镜术后应用空气压力波治疗仪联合低分子肝素钙注射液预防下肢深静脉血栓形成的疗效观察[J]. 中国性科学, 2020, 29(12): 43-46. [Gong S, Jin HH, Jiang L, et al. Therapeutic effect of air pressure combined with low molecular heparin calcium in-jection on prevention of lower extremity deep venous thrombosis in patients with gyneco-logical malignant tumor after laparoscopic surgery[J]. Chinese Journal of Human Sexuality, 2020, 29(12): 43-46.] DOI: 10.3969/j.issn.1672-1993.2020.12.014.

22.莫金凤. 低分子肝素联合气压治疗在腹腔镜妇科恶性肿瘤术后血栓性疾病的防治临床疗效观察[J]. 中国医药科学, 2020, 10(21): 117-119, 155. [Mo JF. Observation of the clinical efficacy of low mo-lecular weight heparin combined with air pressure treatment in preventing and treating thrombotic diseases after laparoscopic surgery for gynecological malignant tumors[J]. China Medicine and Pharmacy, 2020, 10(21): 117-119, 155.] DOI: 10.3969/j.issn.2095-0616.2020.21.033.

23.徐淑云. 间歇式充气压力泵预防妇科恶性肿瘤患者术后下肢深静脉血栓的疗效[J]. 中国医药指南, 2020, 18(31): 56-57. [Xu SY. Effect of intermittent pneumatic pressure pump on prevention of venous thrombosis of lower extremity after gynecological malignant tumor surgery[J]. Guide of China Medicine, 2020, 18(31): 56-57.] DOI: 10.15912/j.cnki.gocm.2020.31.025.

24.余佳佳. 低分子肝素钙联合逐级加压弹力袜对预防妇科肿瘤术后患者下肢深静脉血栓的影响[J]. 医疗装备, 2020, 33(13): 177-178. [Yu JJ. Effect of low molecular weight heparin calcium combined with stepwise compression elastic stockings on prevention of deep vein thrombosis of lower extremities in patients after gynecological tumor surgery[J]. Chinese Journal of Medical De-vice, 2020, 33(13): 177-178.] DOI: 10.3969/j.issn.1002-2376.2020.13.099.

25.张沛, 侯青霞. 低分子肝素钙在妇科肿瘤腹腔镜术后深静脉血栓预防中应用价值观察[J]. 海峡药学, 2018, 30(12): 141-143. [Zhang P, Hou QX. Application value of low molecular weight heparin calcium in the prevention of deep vein thrombosis after laparoscopic gynecological tumor surgery[J]. Strait Pharmaceutical Journal, 2018, 30(12): 141-143.] DOI: 10.3969/j.issn.1006-3765.2018. 12.067.

26.余鸿标, 唐杰, 杜敏, 等. 弹力袜配合依诺肝素钠联合气压治疗仪治疗在预防妇科恶性肿瘤术后并发DVT中的效果观察[J]. 中国临床新医学, 2018, 11(11): 1122-1124. [Yu HB, Tang J, Du M, et al. Effect of elastic stockings combined with enoxaparin sodium and barometric pressure therapy on prevention of postoperative deep vein thrombosis in patients with gynecological malignant tumors[J]. Chinese Journal of New Clinical Medicine, 2018, 11(11): 1122-1124.] DOI: 10.3969/j.issn. 1674-3806.2018.11.15.

27.朱景瑞, 夏宾. 低分子肝素钙联合逐级加压弹力袜预防妇科恶性肿瘤患者术后下肢深静脉血栓的临床研究[J]. 中国实用医刊, 2018, 45(22): 7-9, 13. [Zhu JR, Xia B. Clinical study of low molecular weight heparin calcium combined with graduated compression stockings in preventing deep venous thrombosis of lower extremity in postoperative patients with gynecological malig-nant tumors[J]. Chinese Journal of Practical Medicine, 2018, 45(22): 7-9, 13.] DOI: 10.3760/cma.j.issn.1674-4756. 2018.22.003.

28.孙会敏, 李风芹, 郝学平. 低分子肝素钙对妇科腹腔镜术后深静脉血栓的预防效果观察[J]. 中国医学工程, 2018, 26(8): 109-111. [Sun HM, Li FQ, Hao XP. Observation of the preventive effect of low molecular weight heparin calcium on deep vein thrombosis after gynecological laparosco-py[J]. China Medical Engineering, 2018, 26(8): 109-111.] DOI: 10.19338/j.issn.1672-2019. 2018.08.029.

29.金微微, 汝薇. 弹力袜在妇科肿瘤病人术后的应用[J]. 黑龙江医药科学, 2018, 41(4): 90-91. [Jin WW, Ru W. Application of elastic stockings in gynecological tumor patients after operation[J]. Heilongjiang Medicine and Pharmacy, 2018, 41(4): 90-91.] DOI: CNKI:SUN:KXJY.0. 2018-04-042.

30.李晓娟, 周勤, 张红卫, 等. 围术期干预对妇科恶性肿瘤患者术后下肢深静脉血栓形成的预防效果评价[J]. 中国病案, 2018, 19(2): 108-112. [Li XJ, Zhou Q, Zhang HW, et al. Prevention effect of peri-operative intervention on deep vein thrombosis in lower extremity of gynecologic malignant tumor patients[J]. Chinese Medical Record, 2018, 19(2): 108-112.] DOI: 10.3969/j.issn.1672-2566. 2018.02.038.

31.许美华, 邱锡坚, 陈县, 等. 低分子肝素钙联合气压波治疗仪预防卵巢癌术后下肢深静脉血栓形成的临床观察[J]. 广东医学院学报, 2015, 33(1): 110-112. [Xu MH, Qiu XJ, Chen X, et al. Clinical observa-tion on the application of low molecular heparin calcium combined with air pressure therapy in prevention of deep venous thrombosis[J]. Journal of Guangdong Medical College, 2015, 33(1): 110-112.] DOI: 10.3969/j.issn.1005-4057. 2015.01.032.

32.李文洲, 吴伶俐, 王召云. 低分子肝素在妇科肿瘤术后预防下肢深静脉血栓中的作用[J]. 福建医药杂志, 2013, 35(6): 91-93. [Li WZ, Wu LL, Wang ZY. The role of low molecular weight heparin in the prevention of lower extremity deep venous thrombosis after gynecological tumor surgery[J]. Fujian Medical Journal, 2013, 35(6): 91-93.] DOI: CNKI:SUN:FJYY.0.2013-06-047.

33.Dainty L, Maxwell GL, Clarke-Pearson DL, et al. Cost-effectiveness of combination throm-boembolism prophylaxis in gynecologic oncology surgery[J]. Gynecol Oncol, 2004, 93(2): 366-373. DOI: 10.1016/j.ygyno.2004.02.004.

Hot Papers