The Research On The Prevention Of Deep Venous Thrombosis By Using Low-molecular-weight Heparin For The Patients Who Were After Gynecological Neoplasm Surgery

Objective:Postoperative with gynecologic neoplasm who were with a Caprini RAM score of ?3 were treated with prophylactic anticoagulation by using low-molecular-weight heparin at different time after surgery.A series of observations and contradistinctions to the incidence and its complications of deep venous thrombosis had been made,to explore the optimal time for the application of low molecular weight heparin in the prevention of venous thrombosis after gynecologic cancer surgery,and to provide an objective clinical basis for the prevention of complications of deep venous thrombosis after gynecological tumor surgery.Materials and Methods:This study is a prospective-case-control study.A total of 160 cases,for which the patients with gynecologic neoplasm underwent a laparoscopic surgery under general anesthesia with the intubation,had been collected from January 2016 to January 2018 at the Gynecology Department of Guangzhou First Municipal People's Hospital,all patients had a Caprini RAM score of ?3 after surgery,and they had been randomly divided into control group and 3 intervention groups.The intervention groups were divided into intervention group 1(6 hours after operation),intervention group 2(12 hours after operation),and intervention group 3(24 hours after operation)according to the time of starting to use low-molecular-weight heparin for treatment after surgery.According to the time of intervention,4100 IU of low-molecular-weight heparin was used for prophylactic anticoagulant therapy subcutaneously once a day for 5 days.The control group did not use any other anticoagulants and drugs that affect coagulation function after surgery.The data such as Hb,PLT,PT,APTT,INR,FIB,D-Dimer values,clinical signs and symptoms,incidence of venous thrombosis in the lower extremities and incidence of postoperative bleeding were collected during the time of before surgery,on the first postoperative day,and on the fifth postoperative day,and all of collecting data were compared between the four groups.Results: 1.The Caprini RAM score after surgery in the enrolled patients revealed that 93.1% of patients were at high risk of venous thrombosis(?5 points).2.Five cases with deep venous thrombosis were found in the control group,and one case of deep venous thrombosis was found in each of the intervention group 2 and intervention group 3,there was no deep venous thrombosis occurred in the intervention group 1.The incidence of DVT in the control group(12.5%)was significantly higher than the total incidence of DVT in other three intervention groups(1.67%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of deep venous thrombosis among the three intervention groups(P>0.05).3.No postoperative bleeding occurred in the control group.There was one case of postoperative bleeding in each group of the intervention group.There was no significant difference in the incidence of postoperative bleeding between four groups(P>0.05).4.The FIB and D-Dimer values of the intervention group 1 and the intervention group 2 on the first postoperative day were lower than those of the control group and the intervention group 3(P<0.05).The D-Dimer value of the intervention group 1 on the fifth postoperative day was lower than those of the control group,the intervention group 2,and the intervention group 3,and the difference was statistically significant(P<0.05).5.There were no significant difference in Hb,PLT,PT,APTT,and INR between four groups during the time of preoperative and postoperative(P>0.05).Conclusion: 1.Almost all patients with gynecologic neoplasm are in high-risk of DVT after surgery,attention should be paid to Caprini RAM assessment,and use risk assessment as a guide to prevent venous thrombosis.2.Postoperative who were treated by using low-molecular-weight heparin for prophylactic anticoagulant therapy can effectively improve their hypercoagulability of the body,significantly reduce the incidence of deep venous thrombosis,and will not increase the risk of postoperative bleeding.3.The earlier of preventing anticoagulant therapy should be better in effect,and would not increase the risk of postoperative bleeding.Compared with the three intervention groups,the best treatment outcome was the use of low molecular weight heparin prophylactic anticoagulation therapy starting 6 hours after surgery.4.There is no need to monitor coagulation during prophylactic anticoagulation with low molecular weight heparin,and D-dimer is an effective laboratory indicator for monitoring thrombosis.