Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy. A prospective trial

We initiated a prospective, partially randomized trial of the effects of perioperative prophylactic mini-dose heparin on the incidence of clinically evident pulmonary emboli, intraoperative blood loss, blood transfusions, duration of postoperative pelvic drainage, and lymphocele formation in 68 consecutive patients undergoing radical retropubic prostatectomy. We treated 32 patients with mini-dose heparin and 36 without it. We detected pulmonary emboli in 4 (11%) patients not treated with mini-dose heparin and in none treated with heparin (p = 0.052). Anesthesiologists estimated a mean intraoperative blood loss of 2,152 cc in the heparinized patients compared with 1,886 cc in controls (p = 0.2). At a time when our policy was to replace all blood loss, we transfused a mean of 3.9 units to heparinized patients and 3.2 units to controls (p = 0.1). Persistent lymphatic drainage requiring more than six days of closed suction drainage occurred in 12 of 32 (38%) heparinized patients as compared with 4 of 36 (11%) controls (p = 0.01). We discontinued the study after 68 patients because of the morbidity associated with mini-dose heparin. Because of the associated morbidity we do not recommend the routine use of mini-dose heparin in patients undergoing radical prostatectomy.