Effect Of Low Molecular Weight Heparin Sodium On Preventing Deep Vein Thrombosis After Gynecological Operation

Objective:The purpose of this study was to observe the effect of low molecular weight heparin sodium on preventing deep vein thrombosis after gynecological surgery,and to explore and verify the preventive effect of low molecular weight heparin sodium on deep vein thrombosis.Methods:A total of 142 patients who underwent surgical treatment in the Department of Gynecology of the First Affiliated Hospital of Kunming Medical University from March 2022 to December 2022 were selected.D-dimer detection and ultrasound examination of both lower extremity blood vessels were performed before surgery to prevent deep vein thrombosis.According to G-Caprini model,the patients are divided into: 46 cases in a low-risk group(0 points),56 cases in a medium-risk group(1 point),and 40 cases in a high-risk group(≥2 points).Then,according to the recommended preventive measures for deep vein thrombosis in expert consensus,stratified prevention was carried out: the low-risk group began to get out of bed as soon as possible after surgery;The intermediate risk group was treated with intermittent balloon pressure device within 12 to 24 hours after surgery(twice a day,30 minutes each time).The high-risk group was prophylaxis with intermittent balloon pressure device and low molecular weight heparin sodium(4250 IU subcutaneously,once a day)within 12 to 24 hours after surgery.All patients were required to undergo general hematological analysis,four coagulation tests,three fibrinolysis tests,liver and kidney function tests,and five lipid tests before surgery.General hematologic analysis,four coagulation tests,and three fibrinolysis tests were re-examined on the first day after surgery(D1)and the fourth day after surgery(D4).To observe the effect of preventing postoperative deep vein thrombosis in three different groups during hospitalization.Results:1.Comparison of preoperative general data among the three groups:average age: 35.8 ± 9.96 years old in low-risk group,45.82 ± 9.15 years old in middle-risk group;and 56.15 ± 9.31 years old in high risk group;There was significant difference among the three groups(P < 0.05).Average BMI: low risk group 22.61 ±2.83 kg/m~2;middle-risk risk group 23.34 ± 2.95 kg/m~2;The high-risk group was 24.59± 3.25 kg/m~2,and there was significant difference among the three groups(P < 0.05).Hypertension history: 0 cases in low-risk group,9 cases in middle-risk group(16.07%);and 21 cases(52.5%)in high-risk group;there was significant difference among the three groups(P < 0.05).Diabetes history: 1 case(2.17%)in low-risk group;1 case(1.79%)in the medium-risk group;and 4 cases(10%)in high-risk group;there was no statistical significance among the three groups(P > 0.05).Malignant tumor history: 1case(2.17%)in low-risk group;5 cases(8.93%)in the middle-risk group and 11 cases(27.5%)in high-risk group;there was significant difference among the three groups(P< 0.05).Hyperlipidemia: 2 cases(4.35%)in the low-risk group;13 cases(23.21%)in the middle-risk group,and 10 cases(25%)in high-risk group;there was significant difference among the three groups(P < 0.05).Preoperative DD2≥0.5mg/L: 0 cases in the low-risk group,0 cases in the medium-risk group,and 5 cases in the high-risk group(12.5%),with significant difference among the three groups(P < 0.05).2.Changes of D1 and D4 related indexes in three groups before and after surgery:General hematological analysis: HGB and PLT of D1 and D4 at three time points before and after surgery were not statistically significant among three groups(P >0.05).Fibrinolysis three: there was no significant difference in preoperative FDP and TIIIA among the three groups(P > 0.05),but the level of preoperative DD2 in high-risk group was higher than that in low and medium-risk groups,and the difference was significant(P < 0.05).The levels of FDP and DD2 in D1 high-risk group were higher than those in low and medium-risk groups,and the difference was significant(P < 0.05).The levels of FDP and DD2 in high-risk group D4 after surgery were decreased compared with D1,and there was no significant difference in FDP and DD2 among the three groups after surgery(P > 0.05).There was no significant difference in TIIIA between D1 and D4 groups after surgery(P > 0.05).There was no significant difference in PT and APTT at D1 and D4 time points before and after operation(P > 0.05).There was no significant difference in FIB among the three groups before surgery(P > 0.05),but the FIB level of D1 and D4 high-risk groups was higher than that of low and medium-risk groups after surgery,and the difference was significant(P < 0.05).Preoperative TT was significantly different among the three groups(P < 0.05),postoperative D1 TT was not significantly different(P >0.05),postoperative D4 high-risk group TT was lower,medium risk group prolonged,the difference was significant(P < 0.05).3.Effect of different DVT risk grouping and stratification on prevention of deep vein thrombosis in the three groups: there was no occurrence of deep vein thrombosis in the low,medium and high risk groups after surgery(during hospitalization).Conclusion : 1.Screening D-dimer quantity before gynecological operation,D-dimer quantity ≥0.5mg/L,ultrasound examination of lower limb blood vessels to prevent the occurrence of DVT is beneficial to timely diagnosis and treatment of DVT.2.Score the high risk factors of deep vein thrombosis in gynecological surgery patients based on G-Caprini model and give different preventive measures according to the score is beneficial for clinical management and treatment of deep vein thrombosis.Getting out of bed as soon as possible after surgery,12-24 hours of intermittent lower limb balloon pressure device,low molecular weight heparin sodium in different DVT risk levels all play a role in preventing postoperative DVT.3.Postoperative use of low molecular weight heparin sodium can significantly reduce the postoperative D-dimer quantity,activate the fibrinolytic system of the body,improve coagulation function,and form a blood system environment that is not conducive to thrombosis.It has a significant effect on the prevention of postoperative DVT,and the bleeding tendency is controllable and safe.4.In addition to the high risk factors for DVT mentioned in G-Caprini model,such as age,hypertension,varicose veins,operation time ≥3 hours,open surgery,and postoperative bed time ≥48 hours,this study finds that obesity,history of malignant tumor,high blood fat,and preoperative DD2≥0.5 mg/L are also high risk factors for DVT.It is worth our further attention and research in the future clinical work.