[Removal of the uterus and adnexa and use of low-molecular weight heparin]

Histological changes of ligated vasa ovarica, uterina, plica lata, mesosalpinx, mesovarium etc. were studied in 30 women. Thrombus formation, damage of the vessel wall, endothelial cell and tissue bleeding was observed after 30 min. We resected the ligated stumps during the operation, before operation an injection of LMWH was given. No complete, typical occlusive thrombi developed near the ligature. In 3 cases we found evidence of parietal thrombus formation made up of platelets in the art. uterina (10.0%) and in 4 cases in veins, and in a few cases fibrin was present (13.3%). These changes were found in the same number in the vasa ovarica. LMWH reduced the vascular, endothelial damage and the incidence of tissue bleeding. Clinical gynecological experience suggests their safety and effectiveness in thromboprophylaxis. The rapid and direct obliteration of the vascular lumen is due to proliferation of tissue fibroblasts and muscle cells, no bleeding occurred after demarcation of the distal stumps and. LMWH significantly reduces intravasal changes by important intraoperative reactions against thromboplastin generation and haemostasis and can completely replace standard heparin in gynecological prophylaxis.