Venous thrombosis prophylaxis for urological laparoscopy: fractionated heparin versus sequential compression devices

Venous thromboembolism (VTE) is a significant postoperative complication. Common methods of VTE prophylaxis include subcutaneous fractionated heparin (FH) and lower extremity sequential compression devices (SCD). There is no conclusive evidence supporting 1 method compared to the other for urological laparoscopy. We examined the rates of postoperative hemorrhagic and thrombotic complications after laparoscopic urological procedures in patients treated with FH or SCD as VTE prophylaxis.

A prospective database augmented by retrospective chart review included all patients who underwent urological laparoscopic surgery of the upper retroperitoneum at our institution from June 2000 to December 2002. Patients nonrandomly received FH or SCD as VTE prophylaxis beginning on the day of surgery.

A total of 344 patients were included in this study, 172 in the FH group and 172 in the SCD group. Thrombotic complications included VTE and/or pulmonary embolism. Hemorrhagic complications were minor or major, the latter requiring transfusion or other intervention. In both groups the rate of thrombotic complication was 2 of 172 (1.2%). The rate of hemorrhagic complication was 16 of 172 (9.3%) in the FH group, of which 12 of 172 (7.0%) were major. The hemorrhagic complication rate was 6 of 172 (3.5%), with 5 of 172 (2.9%) being major in the SCD group.

After urological laparoscopy of the upper retroperitoneum, subcutaneous fractionated heparin is associated with increased hemorrhagic complications (p = 0.045), without a reduction in thrombotic complications (p >0.999), compared with sequential compression devices.