[Prevention of deep vein thrombosis (DVT) with the low molecular weight heparin (LMWH) and epidural/spinal anesthesia. The efficacy viewpoint]. / Profilaktyka zylnej choroby zakrzepowo-zatorowej (ZChZZ) niskoczasteczkowa heparyna (LMWH), a znieczulenie zewnatrzoponowe i podpajeczynówkowe. Aspekt skutecznosci.

OBJECTIVES: To compare the frequency of DVT and PE (pulmonary embolism) events in patients who had undergone gynecological operations under epidural/spinal anaesthesia without LMWH prophylaxis with patients receiving LMWH prophylaxis. DESIGN: Retrospective, hospital record based study. MATERIALS AND METHODS: The majority of patients had undergone vaginal operations. 441 consecutive, unselected patients without LMWH prophylaxis vs. 463 ones treated with LMWH. The patients were given Fraxiparine a 7,500 ICU s.c. 2 h before operation. The same doses were repeated every 24 h during 5-7 days or to the regaining by the patient sufficient physical activity. DVT diagnosis was based on the clinical signs and ultrasound techniques. PE was stated on clinical symptoms, ECG chest x-ray characteristics and gasometric data. RESULTS: Among the patients without LMWH prophylaxis 2 cases of PE occurred (0.45%), one of these was fatal. 1 case of proximal DVT (0.23%) and 3 distal DVT complications (0.68%) were stated. In the LMWH group 1 proximal DVT (0.22%) and 2 distal DVT (0.43%) developed. CONCLUSIONS: Perioperative LMWH prevention proved to be efficient. The clinically expressed incidence of DVT expressively diminished: 8 cases-(1.66%) vs. 3 cases-(0.53%). The pulmonary embolism was avoided.

[Spinal analgesia and perioperative low molecular weight heparin (LMWH) prophylaxis of thrombosis. Safety aspect]. / Znieczulenie zewnatrzoponowe i podpajeczynówkowe a okolooperacyjna profilaktyka przeciwzakrzepowa niskoczasteczkowa heparyna. Aspekt bezpieczenstwa.

For many gynecological surgery patients belonging to deep vein thrombosis (DVT) high-risk group the analgesia of choice is regional spinal analgesia. Perioperatively LMWH--Fraxiparine was administered to 426 gynecological surgery patients and to 113 caesarean section patients. The first dose 7500 ICU s.c. was administered 2 hours before operation and consecutive ones every 24 hours for 5 to 7 days. The drug didn't cause any anaesthesia complications like enhanced bleeding after lumbar punction. It was emphasised in the discussion that in choosing this kind of prophylaxis certain conditions should be fulfilled in order to avoid spinal hematoma.