The Effect of Low‐dose Subcutaneous Heparin on Wound Haemorrhage, a Controlled Study of Mastectomy Patients

Steele, R. J. C.; Richmond, J.; Lee, D.; Chetty, U.; Davies, G C

doi:10.1111/j.1742-1241.1983.tb07144.x

Int J Clinical Practice

1983

DOI: 10.1111/j.1742-1241.1983.tb07144.x

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The Effect of Low‐dose Subcutaneous Heparin on Wound Haemorrhage, a Controlled Study of Mastectomy Patients

R. J. C. Steele¹,

J. Richmond²,

D. Lee³

et al.

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Cited by 6 publications

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“…It is well documented that low‐molecular‐weight heparin (LMWH) and unfractionated heparin in small doses reduce the incidence of postoperative thromboembolic complications after general, orthopedic, and gynecologic surgery [6, 7]. Some studies, however, indicate that heparin increases the risk of hematoma and seroma after breast surgery compared to no thromboembolic prophylaxis [8, 9] or the use of graded compression (TED) stockings [10]. Graded compression stockings reduce the thromboembolic risk following venous stasis by improving venous blood flow in the lower extremities during immobilization and enhancing both local and systemic fibrinolysis [6, 11, 12].…”

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Thromboembolic Prophylaxis as a Risk Factor for Postoperative Complications after Breast Cancer Surgery

et al. 2004

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Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through August 1996, a series of 425 patients consecutively operated on for primary breast cancer were included. Thromboembolic prophylaxis was low-molecular-weight heparin (LMWH) in 310 patients and thigh-long graded compression (TED) stockings in 102 patients. Postoperative complications including deep vein thrombosis, pulmonary embolism, wound hematoma, and sugillation were recorded, and 17 variables with a potential influence on complications were analyzed by logistic regression analysis. Heparin prophylaxis compared to prophylaxis with TED stockings was significantly and independently associated with postoperative hematoma [odds ratio (OR) 3, 13; 95% confidence interval (CI) 1.38-7.13] or sugillation (OR 3.34; 95% CI 1.93-5.78). No clinically overt thromboembolic complications were diagnosed. After operations for breast cancer we found that LMWH was significantly associated with postoperative hematoma and sugillation compared to TED stockings for perioperative thromboembolic prophylaxis.

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Thromboembolic Prophylaxis as a Risk Factor for Postoperative Complications after Breast Cancer Surgery

et al. 2004

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Prevention of venous thromboembolism in surgical patients with breast cancer

Patiar

Kirwan

McDowell

et al. 2007

British Journal of Surgery

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The absence of randomized trials comparing different methods of VTE prophylaxis with controls makes an evidence-based consensus among breast cancer surgeons difficult. Intermittent pneumatic compression (IPC) and graduated compression (GC) are effective in reducing VTE without the haemorrhagic complications associated with heparin; their effects are additive. The authors suggest the following strategy. All patients undergoing surgery for breast cancer should receive both IPC and GC, with heparin reserved for those at very high risk. A controlled trial should randomize women to receive heparin or not, and all women should have both IPC and GC. The primary endpoints should be the development of VTE and/or haemorrhagic complications.

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Use of enoxaparin results in more haemorrhagic complications after breast surgery than unfractionated heparin

Hardy

Williams

Dixon

2008

British Journal of Surgery

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Background: Low molecular weight heparin (LMWH) is used in preference to unfractionated heparin (UFH) for the prevention of postoperative thromboembolism in many UK surgical units. There are, however, conflicting reports on the relative risk of significant bleeding in surgical patients, and no data exist in the literature for patients undergoing breast surgery. Conclusion: LMWH thromboprophylaxis was associated with a significant increase in haemorrhagic complications after breast surgery compared with UFH.

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The Effect of Low‐dose Subcutaneous Heparin on Wound Haemorrhage, a Controlled Study of Mastectomy Patients

Cited by 6 publications

References 9 publications

Thromboembolic Prophylaxis as a Risk Factor for Postoperative Complications after Breast Cancer Surgery

Thromboembolic Prophylaxis as a Risk Factor for Postoperative Complications after Breast Cancer Surgery

Prevention of venous thromboembolism in surgical patients with breast cancer

Use of enoxaparin results in more haemorrhagic complications after breast surgery than unfractionated heparin

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