Antithrombotic drugs in pelvic surgery

From the discussion, it is clear that several agents are available for the prophylactic antithrombotic management of pelvic surgery. Unlike other surgical procedures, the interventions are performed in women with many physiologic and pathologic predisposing factors. There is an increased risk of bleeding in these patients and the selection of an antithrombotic drug with a high safety to efficacy ratio is imperative. Although the introduction of newer drugs, such as defibrotide and low molecular weight heparins, provides certain advantages over the conventional drugs, large-scale prospective clinical trials are required to justify their use. Combination therapy will also be a useful and more effective approach in the management of pelvic surgical patients. However, optimization of dosage and an empiric determination of the safety and efficacy of different drugs used in combination will have to be made. Newer therapeutic agents will have a direct impact in this area in coming years. The practicing clinician should keep an open mind to provide better patient care.