Prophylactic management of venous thromboembolism among patients with gynaecological malignancy : a pilot study between fondaparinux and low molecular weight heparin (tinzaparin)

Abstract

Deep vein thrombosis and pulmonary embolism (PE) are two major complications after gynaecological surgery in which can result in significant morbidity and mortality. It is commonly referred to as venous thrombeombolic events. The purpose of this study was to compare the safety and efficacy between subcutaneous tinzaparin and subcutaneous fondaparinux as prophylaxis post operation. Another purpose of the study was to assess the socio-demographic characteristics and risk factors of developing VTE among patients with gynaecological malignancy postoperatively. We conducted a cross-sectional pilot study on patients who have undergone gynaecological surgeries at Hospital Raja Perempuan Zainab II (HRPZ II) from January 2013 to January 2015. For the demographic data, information regarding the patient’s age, body mass index (BMI), CA 125 level, platelet, coagulation profile, creatinine level, final histological diagnosis, FIGO stage, surgical procedure done, duration of operation and estimated blood loss were taken. For each patient who underwent gynaecological surgery, VTE prophylaxis either fondaparinux 2.5mg daily or tinzaparin sodium 3500u or 4500u daily was initiated postoperatively and was continued until 30 days. Evaluation was done to assess the efficacy and safety of each drug. The data were analysed using SPSS version 20.0 and p value <0.05 was considered statistically significant. Based on the results, none of the patients developed VTE postoperatively while on these anticoagulants. There were two cases of hematoma at the operation site in which occurred in the Tinzaparin group and treated conservatively. Therefore, as a conclusion, our study has suggested fondaparinux, a synthetic selective factor Xa inhibitor is equally effective in term efficacy and safety as a thromboprophylaxis in gynaeoncological surgery. However, further study with larger sample size is necessary to confirm in symptomatic as well as asymptomatic VTE. Fondaparinux is derived from plant extract which make the drug is more acceptable by patients who are concerned about the religious issue.